| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,141 |
1,135 |
$74K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
89 |
68 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
564 |
562 |
$42K |
| D9430 |
|
1,289 |
1,077 |
$41K |
| D1110 |
Prophylaxis - adult |
389 |
389 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
695 |
694 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
264 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,819 |
1,771 |
$28K |
| D4341 |
|
410 |
122 |
$27K |
| D4910 |
|
336 |
333 |
$26K |
| D0350 |
|
2,031 |
842 |
$18K |
| D1120 |
Prophylaxis - child |
298 |
298 |
$14K |
| D0274 |
Bitewings - four radiographic images |
668 |
661 |
$14K |
| D1206 |
Topical application of fluoride varnish |
427 |
420 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
546 |
$7K |
| D1320 |
|
406 |
406 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
27 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
315 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |
| D0270 |
|
12 |
12 |
$55.00 |