| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,364 |
2,348 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,858 |
1,019 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,684 |
860 |
$91K |
| D1120 |
Prophylaxis - child |
1,987 |
1,971 |
$77K |
| D9430 |
|
2,086 |
1,856 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,222 |
3,719 |
$61K |
| D0350 |
|
5,079 |
2,263 |
$56K |
| D4910 |
|
707 |
701 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
712 |
709 |
$46K |
| D2140 |
|
866 |
426 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,208 |
2,190 |
$39K |
| D1110 |
Prophylaxis - adult |
371 |
371 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,677 |
2,660 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
236 |
129 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
568 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
403 |
250 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,145 |
1,891 |
$25K |
| D4341 |
|
183 |
50 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
25 |
24 |
$12K |
| D4342 |
|
89 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
121 |
32 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D7111 |
|
38 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
57 |
57 |
$628.00 |