| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,155 |
2,149 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,127 |
1,118 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,654 |
970 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,362 |
1,355 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,597 |
1,593 |
$76K |
| D2740 |
Crown - porcelain/ceramic |
152 |
103 |
$72K |
| D1120 |
Prophylaxis - child |
1,522 |
1,520 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
414 |
213 |
$49K |
| D9430 |
|
1,011 |
909 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,154 |
1,258 |
$29K |
| D0350 |
|
2,979 |
1,384 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,185 |
1,183 |
$16K |
| D1110 |
Prophylaxis - adult |
139 |
139 |
$13K |
| D0274 |
Bitewings - four radiographic images |
573 |
573 |
$12K |
| D4910 |
|
91 |
91 |
$7K |
| D4342 |
|
137 |
44 |
$6K |
| D0272 |
Bitewings - two radiographic images |
374 |
373 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
264 |
263 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
18 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$2K |
| D2140 |
|
26 |
16 |
$1K |
| D2330 |
|
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
108 |
$1K |
| D1351 |
Sealant - per tooth |
51 |
17 |
$1K |
| D1330 |
|
70 |
70 |
$0.00 |