| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,990 |
1,980 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,456 |
550 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
797 |
340 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,670 |
527 |
$91K |
| D1110 |
Prophylaxis - adult |
1,011 |
1,008 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,735 |
1,725 |
$83K |
| D9430 |
|
2,259 |
2,105 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
787 |
780 |
$60K |
| D2332 |
|
641 |
88 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
70 |
54 |
$33K |
| D0350 |
|
3,184 |
999 |
$32K |
| D0330 |
Panoramic radiographic image |
836 |
836 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,684 |
1,672 |
$24K |
| D1120 |
Prophylaxis - child |
436 |
436 |
$22K |
| D4341 |
|
274 |
100 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,870 |
1,221 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
525 |
516 |
$6K |
| D0272 |
Bitewings - two radiographic images |
354 |
354 |
$4K |
| D0270 |
|
315 |
306 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |