| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,483 |
$164K |
| D1110 |
Prophylaxis - adult |
1,781 |
1,767 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
1,887 |
1,866 |
$140K |
| D1120 |
Prophylaxis - child |
1,867 |
1,852 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
157 |
132 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,629 |
3,633 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,110 |
4,079 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,054 |
1,052 |
$50K |
| D9430 |
|
1,263 |
1,208 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,693 |
1,681 |
$36K |
| D0350 |
|
1,608 |
849 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,221 |
1,168 |
$14K |
| D1351 |
Sealant - per tooth |
300 |
62 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
76 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
36 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
56 |
24 |
$6K |
| D7230 |
|
22 |
12 |
$4K |
| D1310 |
|
89 |
85 |
$4K |
| D9222 |
|
24 |
24 |
$3K |
| D9610 |
|
58 |
24 |
$2K |
| D0601 |
|
12 |
12 |
$180.00 |