| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,183 |
2,171 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,451 |
834 |
$96K |
| D4341 |
|
1,164 |
334 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,746 |
1,735 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,345 |
713 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
845 |
837 |
$55K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
115 |
92 |
$55K |
| D4910 |
|
648 |
646 |
$50K |
| D0350 |
|
4,549 |
1,388 |
$42K |
| D9430 |
|
520 |
500 |
$16K |
| D0274 |
Bitewings - four radiographic images |
714 |
706 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
81 |
$13K |
| D1110 |
Prophylaxis - adult |
144 |
144 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,087 |
1,473 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
929 |
923 |
$10K |
| D1120 |
Prophylaxis - child |
282 |
280 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
478 |
$6K |
| D4342 |
|
104 |
42 |
$4K |
| D2330 |
|
46 |
29 |
$3K |
| D1206 |
Topical application of fluoride varnish |
115 |
114 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$294.00 |