| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,762 |
1,752 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
1,303 |
1,294 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,304 |
789 |
$86K |
| D1120 |
Prophylaxis - child |
1,533 |
1,530 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,042 |
1,038 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
884 |
528 |
$47K |
| D1110 |
Prophylaxis - adult |
374 |
372 |
$32K |
| D9430 |
|
835 |
789 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,286 |
1,275 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,772 |
1,761 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,774 |
2,261 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
113 |
64 |
$13K |
| D0350 |
|
1,240 |
664 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
18 |
14 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
527 |
525 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
46 |
$5K |
| D0272 |
Bitewings - two radiographic images |
309 |
307 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |