| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,491 |
2,479 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
2,542 |
2,519 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,369 |
854 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,399 |
639 |
$92K |
| D1120 |
Prophylaxis - child |
2,007 |
1,987 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,606 |
1,596 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,478 |
3,222 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
111 |
75 |
$53K |
| D8670 |
Periodic orthodontic treatment visit |
167 |
167 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
825 |
334 |
$46K |
| D1110 |
Prophylaxis - adult |
375 |
366 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,039 |
2,022 |
$23K |
| D9430 |
|
575 |
557 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,469 |
1,432 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
25 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,198 |
$12K |
| D0330 |
Panoramic radiographic image |
642 |
640 |
$11K |
| D2954 |
|
101 |
71 |
$10K |
| D4341 |
|
119 |
32 |
$8K |
| D1206 |
Topical application of fluoride varnish |
243 |
242 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
52 |
$1K |
| D1330 |
|
40 |
40 |
$0.00 |
| D0170 |
|
19 |
19 |
$0.00 |