| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,439 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,261 |
1,247 |
$94K |
| D1110 |
Prophylaxis - adult |
953 |
944 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
598 |
316 |
$70K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
137 |
122 |
$65K |
| D1120 |
Prophylaxis - child |
1,246 |
1,226 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,178 |
1,167 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,368 |
1,705 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,219 |
2,190 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
342 |
$33K |
| D0274 |
Bitewings - four radiographic images |
939 |
926 |
$19K |
| D4910 |
|
229 |
229 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
91 |
$10K |
| D4341 |
|
141 |
37 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
77 |
$6K |
| D9430 |
|
195 |
195 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
462 |
461 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
73 |
$876.00 |