| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,235 |
1,228 |
$77K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
162 |
100 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,167 |
1,150 |
$69K |
| D1110 |
Prophylaxis - adult |
617 |
611 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,032 |
1,024 |
$47K |
| D1120 |
Prophylaxis - child |
584 |
571 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
135 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,044 |
1,211 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
61 |
$11K |
| D2954 |
|
99 |
67 |
$10K |
| D4341 |
|
123 |
33 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
67 |
$8K |
| D4910 |
|
103 |
103 |
$8K |
| D0274 |
Bitewings - four radiographic images |
305 |
296 |
$6K |
| D1206 |
Topical application of fluoride varnish |
416 |
416 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
388 |
385 |
$5K |
| D0272 |
Bitewings - two radiographic images |
362 |
360 |
$4K |
| D0350 |
|
269 |
125 |
$3K |
| D2952 |
|
24 |
12 |
$3K |
| D9430 |
|
61 |
59 |
$2K |