| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,004 |
2,987 |
$198K |
| D0330 |
Panoramic radiographic image |
3,356 |
3,338 |
$101K |
| D1110 |
Prophylaxis - adult |
598 |
593 |
$53K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
114 |
106 |
$53K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
50 |
38 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
433 |
427 |
$21K |
| D9430 |
|
589 |
581 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,497 |
2,817 |
$18K |
| D2954 |
|
125 |
92 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
873 |
868 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
67 |
$12K |
| D0350 |
|
757 |
274 |
$7K |
| D3348 |
|
12 |
12 |
$6K |
| D3320 |
|
12 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
298 |
$4K |
| D0270 |
|
515 |
515 |
$3K |
| D2394 |
|
28 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
15 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$682.50 |