| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,077 |
2,055 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,493 |
1,475 |
$60K |
| D9430 |
|
1,383 |
1,192 |
$41K |
| D0350 |
|
4,012 |
1,105 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
65 |
44 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,521 |
1,349 |
$19K |
| D1110 |
Prophylaxis - adult |
223 |
220 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
482 |
464 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
96 |
$10K |
| D0274 |
Bitewings - four radiographic images |
465 |
461 |
$9K |
| D4341 |
|
108 |
30 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
25 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
341 |
332 |
$4K |
| D2954 |
|
36 |
27 |
$4K |
| D1120 |
Prophylaxis - child |
197 |
192 |
$4K |
| D1206 |
Topical application of fluoride varnish |
165 |
160 |
$1K |
| D0272 |
Bitewings - two radiographic images |
285 |
274 |
$1K |
| D1320 |
|
51 |
51 |
$809.39 |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
300 |
$800.50 |
| D4910 |
|
12 |
12 |
$770.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$394.80 |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$390.00 |
| D1330 |
|
15 |
13 |
$0.00 |