| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,575 |
1,570 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,463 |
844 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,653 |
901 |
$89K |
| D4910 |
|
1,041 |
1,037 |
$79K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
160 |
139 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,038 |
1,030 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,441 |
1,434 |
$68K |
| D4341 |
|
806 |
216 |
$56K |
| D0350 |
|
4,407 |
1,680 |
$43K |
| D1120 |
Prophylaxis - child |
890 |
886 |
$40K |
| D9430 |
|
743 |
681 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,731 |
1,725 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,169 |
1,595 |
$17K |
| D0274 |
Bitewings - four radiographic images |
819 |
814 |
$17K |
| D0330 |
Panoramic radiographic image |
211 |
210 |
$6K |
| D2954 |
|
32 |
27 |
$3K |
| D1320 |
|
194 |
190 |
$3K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
114 |
$2K |
| D1206 |
Topical application of fluoride varnish |
41 |
41 |
$386.00 |
| D0270 |
|
16 |
13 |
$80.00 |