| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,934 |
1,933 |
$127K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,766 |
812 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
1,002 |
995 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,421 |
1,420 |
$68K |
| D0350 |
|
5,797 |
2,232 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
458 |
$62K |
| D1120 |
Prophylaxis - child |
1,091 |
1,087 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,332 |
2,057 |
$36K |
| D9430 |
|
1,141 |
1,105 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
666 |
301 |
$36K |
| D2160 |
|
329 |
204 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,521 |
1,516 |
$20K |
| D1110 |
Prophylaxis - adult |
214 |
214 |
$19K |
| D0274 |
Bitewings - four radiographic images |
660 |
657 |
$14K |
| D2140 |
|
208 |
117 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
691 |
$9K |
| D0272 |
Bitewings - two radiographic images |
448 |
448 |
$5K |
| D0330 |
Panoramic radiographic image |
178 |
178 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0270 |
|
29 |
29 |
$130.00 |