| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,528 |
1,512 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,464 |
1,455 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,329 |
1,318 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
786 |
406 |
$47K |
| D1110 |
Prophylaxis - adult |
385 |
384 |
$29K |
| D1120 |
Prophylaxis - child |
657 |
653 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,424 |
1,416 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
215 |
97 |
$22K |
| D9430 |
|
624 |
605 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,875 |
1,821 |
$15K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
12 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
531 |
$6K |
| D2160 |
|
55 |
40 |
$4K |
| D2330 |
|
60 |
27 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
94 |
28 |
$2K |
| D4341 |
|
27 |
12 |
$2K |
| D4342 |
|
26 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
52 |
$452.00 |