| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,502 |
6,472 |
$370K |
| D0350 |
|
37,698 |
10,115 |
$361K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,164 |
2,431 |
$279K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,125 |
2,569 |
$279K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,856 |
3,849 |
$241K |
| D1120 |
Prophylaxis - child |
5,817 |
5,790 |
$229K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,984 |
8,266 |
$179K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
353 |
311 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
3,454 |
3,451 |
$163K |
| D1110 |
Prophylaxis - adult |
1,286 |
1,281 |
$113K |
| D0274 |
Bitewings - four radiographic images |
5,066 |
5,035 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,129 |
7,096 |
$81K |
| D4910 |
|
969 |
961 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
555 |
356 |
$65K |
| D4341 |
|
751 |
205 |
$53K |
| D1351 |
Sealant - per tooth |
1,815 |
502 |
$44K |
| D9430 |
|
1,045 |
1,008 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,905 |
1,898 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
57 |
$6K |
| D4342 |
|
76 |
29 |
$3K |
| D2954 |
|
25 |
24 |
$3K |
| D2330 |
|
22 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$1K |
| D7111 |
|
19 |
13 |
$1K |