| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
641 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
516 |
512 |
$24K |
| D1110 |
Prophylaxis - adult |
289 |
286 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
25 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
407 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
38 |
$5K |
| D9430 |
|
146 |
131 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
12 |
$3K |
| D0350 |
|
117 |
77 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
12 |
$2K |
| D1320 |
|
101 |
100 |
$2K |
| D0330 |
Panoramic radiographic image |
58 |
57 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$158.00 |