| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,691 |
2,683 |
$164K |
| D1110 |
Prophylaxis - adult |
1,892 |
1,886 |
$156K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,191 |
690 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,014 |
2,013 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,208 |
784 |
$81K |
| D2740 |
Crown - porcelain/ceramic |
158 |
124 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,084 |
3,074 |
$64K |
| D1120 |
Prophylaxis - child |
1,819 |
1,815 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,503 |
4,744 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
974 |
586 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,910 |
3,901 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
617 |
290 |
$35K |
| D4341 |
|
472 |
132 |
$29K |
| D9430 |
|
690 |
688 |
$22K |
| D1351 |
Sealant - per tooth |
916 |
233 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,041 |
1,032 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
256 |
256 |
$12K |
| D2330 |
|
128 |
77 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
68 |
$7K |
| D4910 |
|
77 |
77 |
$6K |
| D0272 |
Bitewings - two radiographic images |
261 |
261 |
$3K |