| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,146 |
4,127 |
$262K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
537 |
456 |
$255K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,488 |
3,474 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,668 |
1,184 |
$177K |
| D1120 |
Prophylaxis - child |
4,203 |
4,185 |
$165K |
| D1110 |
Prophylaxis - adult |
1,902 |
1,893 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,397 |
872 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,459 |
5,572 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
1,962 |
1,955 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,817 |
3,809 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
658 |
369 |
$77K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
131 |
122 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,262 |
4,240 |
$48K |
| D0350 |
|
2,869 |
955 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
249 |
109 |
$14K |
| D0272 |
Bitewings - two radiographic images |
860 |
855 |
$10K |
| D3320 |
|
27 |
26 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
82 |
$9K |
| D4910 |
|
72 |
72 |
$6K |
| D4341 |
|
39 |
12 |
$3K |
| D9430 |
|
44 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$468.00 |