| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,642 |
1,632 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
717 |
714 |
$54K |
| D1110 |
Prophylaxis - adult |
498 |
492 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
853 |
846 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
272 |
164 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
454 |
260 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,079 |
1,600 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,764 |
1,751 |
$24K |
| D1120 |
Prophylaxis - child |
372 |
369 |
$15K |
| D0274 |
Bitewings - four radiographic images |
656 |
655 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
26 |
25 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
65 |
$7K |
| D9430 |
|
99 |
95 |
$3K |
| D0350 |
|
252 |
112 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
168 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
108 |
108 |
$1K |