| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,634 |
2,626 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,600 |
1,287 |
$166K |
| D2740 |
Crown - porcelain/ceramic |
326 |
260 |
$155K |
| D0210 |
Intraoral - complete series of radiographic images |
2,406 |
2,397 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
798 |
797 |
$57K |
| D1120 |
Prophylaxis - child |
1,120 |
1,119 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
300 |
144 |
$35K |
| D9430 |
|
1,065 |
1,038 |
$34K |
| D1110 |
Prophylaxis - adult |
392 |
392 |
$33K |
| D4341 |
|
468 |
163 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
366 |
$32K |
| D4910 |
|
384 |
384 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
458 |
$16K |
| D0274 |
Bitewings - four radiographic images |
788 |
787 |
$16K |
| D0330 |
Panoramic radiographic image |
552 |
552 |
$16K |
| D0350 |
|
1,504 |
656 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
906 |
902 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,503 |
1,263 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
90 |
$9K |
| D1206 |
Topical application of fluoride varnish |
606 |
606 |
$9K |
| D1351 |
Sealant - per tooth |
367 |
116 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
174 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
56 |
28 |
$7K |
| D2954 |
|
62 |
55 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
49 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
315 |
310 |
$3K |
| D9993 |
|
53 |
53 |
$3K |
| D1310 |
|
53 |
52 |
$2K |
| D2330 |
|
25 |
17 |
$2K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$2K |
| D0340 |
|
28 |
28 |
$1K |
| D4342 |
|
29 |
14 |
$1K |