| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,406 |
3,345 |
$159K |
| D1110 |
Prophylaxis - adult |
1,771 |
1,736 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
986 |
446 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,516 |
889 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
2,249 |
2,201 |
$88K |
| D9430 |
|
2,925 |
2,634 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,034 |
3,010 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
52 |
29 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
393 |
389 |
$24K |
| D4910 |
|
220 |
219 |
$16K |
| D0330 |
Panoramic radiographic image |
481 |
445 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
217 |
$14K |
| D4341 |
|
264 |
90 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,809 |
1,983 |
$13K |
| D1120 |
Prophylaxis - child |
454 |
446 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,584 |
1,323 |
$12K |
| D0274 |
Bitewings - four radiographic images |
633 |
613 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
55 |
$6K |
| D2394 |
|
33 |
26 |
$2K |
| D2330 |
|
20 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$754.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
15 |
$724.80 |
| D0270 |
|
123 |
99 |
$240.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$100.00 |
| D0350 |
|
87 |
40 |
$78.00 |
| D1999 |
|
38 |
36 |
$0.00 |
| D1310 |
|
94 |
94 |
$0.00 |