| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,592 |
1,587 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,188 |
1,186 |
$56K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
108 |
81 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
635 |
628 |
$42K |
| D1120 |
Prophylaxis - child |
880 |
874 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,971 |
1,366 |
$24K |
| D4341 |
|
325 |
86 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
146 |
$20K |
| D9430 |
|
626 |
567 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,466 |
1,455 |
$16K |
| D0274 |
Bitewings - four radiographic images |
533 |
531 |
$10K |
| D1110 |
Prophylaxis - adult |
84 |
84 |
$7K |
| D4910 |
|
98 |
96 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
50 |
$6K |
| D0350 |
|
280 |
119 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
81 |
$1K |
| D0272 |
Bitewings - two radiographic images |
58 |
55 |
$540.00 |
| D1330 |
|
575 |
571 |
$0.00 |