| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,084 |
2,078 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,360 |
2,349 |
$155K |
| D0210 |
Intraoral - complete series of radiographic images |
2,177 |
2,169 |
$102K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
786 |
281 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,184 |
413 |
$63K |
| D9430 |
|
1,570 |
1,374 |
$50K |
| D0350 |
|
5,386 |
1,522 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
704 |
373 |
$47K |
| D4341 |
|
643 |
175 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
498 |
496 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,390 |
2,380 |
$33K |
| D4910 |
|
366 |
361 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
53 |
28 |
$25K |
| D1120 |
Prophylaxis - child |
453 |
450 |
$19K |
| D2954 |
|
125 |
67 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,892 |
850 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
276 |
$4K |
| D0274 |
Bitewings - four radiographic images |
100 |
100 |
$2K |
| D2330 |
|
24 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D1320 |
|
49 |
49 |
$815.00 |
| D0272 |
Bitewings - two radiographic images |
56 |
56 |
$672.00 |
| D1310 |
|
32 |
32 |
$0.00 |