| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,152 |
4,135 |
$220K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
345 |
241 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,517 |
2,505 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
3,035 |
3,020 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,856 |
1,234 |
$122K |
| D1120 |
Prophylaxis - child |
3,254 |
3,228 |
$118K |
| D1206 |
Topical application of fluoride varnish |
4,850 |
4,830 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
840 |
552 |
$45K |
| D4341 |
|
536 |
150 |
$38K |
| D1110 |
Prophylaxis - adult |
361 |
360 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,038 |
1,032 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
154 |
106 |
$18K |
| D9430 |
|
536 |
533 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,214 |
1,408 |
$13K |
| D2954 |
|
95 |
69 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
659 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
58 |
$6K |
| D0350 |
|
809 |
791 |
$4K |
| D1999 |
|
108 |
108 |
$20.00 |