| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,488 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,234 |
745 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,277 |
1,270 |
$61K |
| D1110 |
Prophylaxis - adult |
676 |
672 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
868 |
481 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
305 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
391 |
391 |
$33K |
| D4341 |
|
467 |
143 |
$32K |
| D4910 |
|
338 |
334 |
$25K |
| D1120 |
Prophylaxis - child |
487 |
479 |
$24K |
| D0350 |
|
2,120 |
737 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,394 |
1,380 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,437 |
671 |
$14K |
| D1351 |
Sealant - per tooth |
312 |
84 |
$12K |
| D9430 |
|
299 |
286 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
12 |
$9K |
| D0274 |
Bitewings - four radiographic images |
348 |
348 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
43 |
$6K |
| D2330 |
|
55 |
32 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
122 |
$1K |
| D1320 |
|
66 |
66 |
$1K |