| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,732 |
1,713 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,690 |
1,673 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
439 |
217 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
758 |
424 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
59 |
51 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
426 |
232 |
$23K |
| D1110 |
Prophylaxis - adult |
246 |
246 |
$22K |
| D9430 |
|
609 |
561 |
$19K |
| D1120 |
Prophylaxis - child |
162 |
162 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
429 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
118 |
117 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,522 |
644 |
$7K |
| D0330 |
Panoramic radiographic image |
632 |
629 |
$5K |
| D4341 |
|
43 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
151 |
150 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D2952 |
|
15 |
12 |
$2K |
| D1320 |
|
39 |
39 |
$660.00 |
| D0350 |
|
65 |
23 |
$624.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$362.00 |
| D0270 |
|
13 |
13 |
$67.00 |
| D1310 |
|
17 |
17 |
$0.00 |
| D0603 |
|
15 |
15 |
$0.00 |