| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,135 |
1,123 |
$74K |
| D1110 |
Prophylaxis - adult |
880 |
878 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
523 |
178 |
$59K |
| D4341 |
|
853 |
223 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
916 |
914 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
187 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
151 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
210 |
210 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,038 |
1,032 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
26 |
14 |
$12K |
| D2330 |
|
97 |
41 |
$8K |
| D1120 |
Prophylaxis - child |
109 |
109 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
385 |
$5K |
| D2332 |
|
60 |
36 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
820 |
467 |
$3K |
| D0274 |
Bitewings - four radiographic images |
111 |
111 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
16 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
78 |
$1K |
| D4910 |
|
15 |
14 |
$1K |