| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,536 |
2,522 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,217 |
1,163 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,248 |
1,080 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,823 |
1,811 |
$112K |
| D1110 |
Prophylaxis - adult |
1,162 |
1,151 |
$103K |
| D1120 |
Prophylaxis - child |
2,385 |
2,367 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,944 |
4,013 |
$73K |
| D0350 |
|
7,025 |
2,258 |
$71K |
| D9430 |
|
1,929 |
1,819 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,205 |
1,197 |
$57K |
| D4910 |
|
681 |
676 |
$52K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
98 |
73 |
$46K |
| D0330 |
Panoramic radiographic image |
1,560 |
1,546 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,083 |
2,071 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
326 |
188 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,988 |
1,971 |
$33K |
| D4341 |
|
408 |
103 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,237 |
2,143 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
156 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,634 |
1,621 |
$15K |
| D1351 |
Sealant - per tooth |
427 |
123 |
$8K |
| D2330 |
|
63 |
30 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
51 |
$5K |
| D2954 |
|
44 |
32 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
22 |
16 |
$0.00 |