| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,929 |
4,909 |
$325K |
| D1110 |
Prophylaxis - adult |
2,921 |
2,905 |
$256K |
| D0210 |
Intraoral - complete series of radiographic images |
4,795 |
4,775 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,276 |
970 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
1,205 |
1,191 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,735 |
3,720 |
$61K |
| D4341 |
|
779 |
208 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
893 |
457 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
100 |
66 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
479 |
284 |
$38K |
| D9430 |
|
1,114 |
1,061 |
$36K |
| D1120 |
Prophylaxis - child |
736 |
736 |
$35K |
| D4910 |
|
409 |
405 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
189 |
87 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,047 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,436 |
2,156 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
43 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
358 |
349 |
$4K |
| D0270 |
|
409 |
398 |
$2K |
| D9110 |
|
32 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$195.00 |