| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,173 |
5,169 |
$298K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,008 |
2,222 |
$268K |
| D1120 |
Prophylaxis - child |
5,206 |
5,193 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,783 |
2,780 |
$178K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,916 |
6,431 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,448 |
1,436 |
$132K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
207 |
162 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,424 |
4,423 |
$92K |
| D1110 |
Prophylaxis - adult |
1,043 |
1,041 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,813 |
1,812 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,120 |
6,109 |
$73K |
| D4341 |
|
968 |
341 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
516 |
271 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
584 |
409 |
$46K |
| D9430 |
|
1,315 |
1,259 |
$41K |
| D4910 |
|
322 |
321 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,521 |
1,514 |
$18K |
| D0350 |
|
1,369 |
846 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
984 |
960 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
74 |
$7K |
| D0330 |
Panoramic radiographic image |
238 |
237 |
$7K |
| D1351 |
Sealant - per tooth |
247 |
84 |
$7K |
| D2330 |
|
47 |
37 |
$4K |
| D2954 |
|
17 |
17 |
$2K |