| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,278 |
2,276 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
1,623 |
1,622 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
154 |
$26K |
| D4341 |
|
369 |
101 |
$25K |
| D0350 |
|
2,231 |
685 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
138 |
$19K |
| D2140 |
|
354 |
125 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
28 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,377 |
861 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
75 |
$13K |
| D1120 |
Prophylaxis - child |
335 |
335 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
105 |
$7K |
| D1110 |
Prophylaxis - adult |
71 |
70 |
$6K |
| D0272 |
Bitewings - two radiographic images |
393 |
391 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
453 |
451 |
$4K |
| D0274 |
Bitewings - four radiographic images |
148 |
147 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
100 |
$1K |
| D9430 |
|
12 |
12 |
$384.00 |