| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
8,180 |
2,739 |
$443K |
| D0210 |
Intraoral - complete series of radiographic images |
1,820 |
1,808 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,476 |
3,472 |
$136K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
450 |
309 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
663 |
241 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,393 |
2,381 |
$57K |
| D1110 |
Prophylaxis - adult |
1,286 |
1,282 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,778 |
1,770 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,643 |
3,599 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,001 |
991 |
$34K |
| D4342 |
|
373 |
124 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
94 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
727 |
722 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
25 |
15 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
52 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
38 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
12 |
$9K |
| D2950 |
|
40 |
38 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
25 |
$5K |
| D4910 |
|
57 |
57 |
$4K |
| D0180 |
|
39 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
45 |
45 |
$910.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$151.58 |