| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,456 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
628 |
627 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,022 |
1,020 |
$49K |
| D4910 |
|
602 |
595 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
83 |
68 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,983 |
1,558 |
$25K |
| D1110 |
Prophylaxis - adult |
278 |
278 |
$24K |
| D4341 |
|
310 |
90 |
$21K |
| D9430 |
|
579 |
556 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
237 |
153 |
$16K |
| D0274 |
Bitewings - four radiographic images |
770 |
769 |
$16K |
| D1120 |
Prophylaxis - child |
306 |
306 |
$15K |
| D0350 |
|
918 |
419 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
566 |
566 |
$8K |
| D1206 |
Topical application of fluoride varnish |
157 |
157 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
149 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$330.00 |
| D0270 |
|
13 |
13 |
$63.75 |