| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,218 |
3,206 |
$212K |
| D1110 |
Prophylaxis - adult |
2,245 |
2,240 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
1,677 |
1,677 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
2,698 |
2,687 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,932 |
1,172 |
$128K |
| D1120 |
Prophylaxis - child |
2,313 |
2,308 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,881 |
1,027 |
$101K |
| D1206 |
Topical application of fluoride varnish |
4,458 |
4,448 |
$72K |
| D0350 |
|
6,643 |
2,516 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
709 |
513 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,707 |
3,043 |
$51K |
| D9951 |
|
1,052 |
401 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,462 |
1,462 |
$31K |
| D2330 |
|
379 |
198 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,358 |
1,990 |
$28K |
| D2335 |
|
192 |
117 |
$23K |
| D9430 |
|
631 |
622 |
$20K |
| D1310 |
|
188 |
188 |
$8K |
| D0330 |
Panoramic radiographic image |
199 |
199 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
470 |
470 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
40 |
$4K |
| D2394 |
|
35 |
31 |
$3K |
| D7111 |
|
20 |
12 |
$1K |
| D2332 |
|
13 |
12 |
$1K |
| D0270 |
|
100 |
92 |
$495.00 |