| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,324 |
3,304 |
$218K |
| D0210 |
Intraoral - complete series of radiographic images |
3,029 |
3,007 |
$142K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,177 |
608 |
$139K |
| D1110 |
Prophylaxis - adult |
713 |
709 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
858 |
359 |
$58K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
81 |
65 |
$39K |
| D9430 |
|
1,037 |
1,005 |
$33K |
| D4341 |
|
431 |
119 |
$30K |
| D1120 |
Prophylaxis - child |
523 |
518 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
183 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
310 |
310 |
$19K |
| D0330 |
Panoramic radiographic image |
833 |
829 |
$14K |
| D4910 |
|
153 |
151 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
737 |
728 |
$11K |
| D0350 |
|
1,616 |
446 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
18 |
13 |
$9K |
| D1206 |
Topical application of fluoride varnish |
515 |
515 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,856 |
794 |
$8K |
| D0274 |
Bitewings - four radiographic images |
276 |
276 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
24 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
124 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
256 |
252 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D0270 |
|
77 |
76 |
$380.00 |