| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
22,870 |
5,644 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
3,008 |
3,003 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,430 |
2,413 |
$153K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
302 |
223 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,599 |
900 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
2,177 |
2,168 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,529 |
700 |
$102K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
843 |
459 |
$99K |
| D1120 |
Prophylaxis - child |
2,315 |
2,305 |
$89K |
| D4341 |
|
1,225 |
375 |
$86K |
| D4910 |
|
900 |
896 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,807 |
3,215 |
$66K |
| D1110 |
Prophylaxis - adult |
674 |
671 |
$56K |
| D9430 |
|
1,598 |
1,510 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,709 |
3,696 |
$46K |
| D2140 |
|
787 |
253 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,891 |
1,883 |
$40K |
| D2954 |
|
282 |
208 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
50 |
47 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
304 |
137 |
$20K |
| D1351 |
Sealant - per tooth |
781 |
223 |
$19K |
| D1320 |
|
660 |
657 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
911 |
905 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
58 |
$6K |
| D0272 |
Bitewings - two radiographic images |
410 |
407 |
$5K |
| D4342 |
|
73 |
27 |
$3K |
| D1999 |
|
121 |
110 |
$138.00 |