| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,459 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,229 |
$75K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
155 |
110 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,450 |
2,432 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
671 |
234 |
$36K |
| D9430 |
|
1,120 |
1,062 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
727 |
725 |
$33K |
| D1110 |
Prophylaxis - adult |
229 |
229 |
$20K |
| D1120 |
Prophylaxis - child |
463 |
460 |
$17K |
| D4341 |
|
199 |
56 |
$14K |
| D0350 |
|
556 |
370 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
627 |
$8K |
| D4910 |
|
96 |
96 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
52 |
$7K |
| D1206 |
Topical application of fluoride varnish |
388 |
387 |
$6K |
| D0272 |
Bitewings - two radiographic images |
495 |
489 |
$5K |
| D0330 |
Panoramic radiographic image |
181 |
179 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
26 |
$4K |
| D0274 |
Bitewings - four radiographic images |
107 |
107 |
$2K |
| D2954 |
|
17 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
124 |
$1K |
| D1999 |
|
12 |
12 |
$0.00 |