| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,752 |
2,746 |
$160K |
| D1110 |
Prophylaxis - adult |
1,558 |
1,551 |
$129K |
| D0350 |
|
13,534 |
2,995 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,682 |
851 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,406 |
$89K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
181 |
153 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,616 |
1,611 |
$75K |
| D1120 |
Prophylaxis - child |
1,803 |
1,797 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
977 |
604 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,418 |
2,410 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,523 |
3,508 |
$42K |
| D9430 |
|
1,219 |
1,176 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,768 |
3,169 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
716 |
705 |
$9K |
| D2330 |
|
62 |
24 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
24 |
$4K |
| D4910 |
|
51 |
51 |
$4K |
| D1351 |
Sealant - per tooth |
103 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
13 |
$1K |
| D0270 |
|
217 |
215 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
33 |
32 |
$46.00 |