| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
647 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,788 |
1,704 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
489 |
483 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
403 |
396 |
$16K |
| D0274 |
Bitewings - four radiographic images |
626 |
624 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
14 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
82 |
$10K |
| D1120 |
Prophylaxis - child |
340 |
327 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
27 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
432 |
421 |
$6K |
| D9430 |
|
145 |
139 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
331 |
$3K |
| D0350 |
|
370 |
172 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
12 |
$2K |
| D1320 |
|
70 |
69 |
$947.50 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$70.00 |