| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,366 |
5,363 |
$355K |
| D1110 |
Prophylaxis - adult |
3,034 |
3,023 |
$265K |
| D0210 |
Intraoral - complete series of radiographic images |
5,050 |
5,048 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,097 |
1,768 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,540 |
1,353 |
$171K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,276 |
668 |
$151K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
263 |
169 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
1,477 |
1,475 |
$102K |
| D4341 |
|
1,089 |
289 |
$76K |
| D1120 |
Prophylaxis - child |
1,714 |
1,709 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,023 |
2,605 |
$62K |
| D9430 |
|
1,669 |
1,645 |
$53K |
| D0350 |
|
3,758 |
1,973 |
$52K |
| D1351 |
Sealant - per tooth |
1,806 |
468 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,907 |
2,904 |
$50K |
| D1320 |
|
2,451 |
2,450 |
$39K |
| D2140 |
|
707 |
326 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
421 |
283 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
476 |
202 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
423 |
186 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,140 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,873 |
1,868 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,425 |
1,411 |
$17K |
| D3221 |
|
150 |
128 |
$9K |
| D4910 |
|
91 |
91 |
$7K |
| D2160 |
|
58 |
34 |
$5K |
| D2940 |
|
45 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
184 |
181 |
$2K |
| D1310 |
|
26 |
26 |
$1K |
| D0270 |
|
14 |
14 |
$71.00 |
| D9993 |
|
13 |
13 |
$0.00 |