| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,053 |
2,042 |
$129K |
| D2740 |
Crown - porcelain/ceramic |
219 |
154 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,728 |
1,717 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
684 |
329 |
$75K |
| D9430 |
|
1,875 |
1,672 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,042 |
1,037 |
$50K |
| D1110 |
Prophylaxis - adult |
414 |
407 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,985 |
2,079 |
$32K |
| D0274 |
Bitewings - four radiographic images |
905 |
898 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,313 |
1,294 |
$17K |
| D1120 |
Prophylaxis - child |
433 |
427 |
$13K |
| D0350 |
|
1,248 |
426 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
102 |
$11K |
| D2954 |
|
47 |
38 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
43 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
42 |
$4K |
| D0270 |
|
518 |
485 |
$3K |
| D0250 |
|
111 |
100 |
$2K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$2K |
| D2140 |
|
19 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
40 |
12 |
$880.00 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$492.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$351.00 |