| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,636 |
2,630 |
$173K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,096 |
654 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
1,891 |
1,872 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
187 |
154 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,684 |
1,679 |
$79K |
| D1120 |
Prophylaxis - child |
1,497 |
1,481 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,074 |
724 |
$70K |
| D1110 |
Prophylaxis - adult |
817 |
811 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,956 |
2,618 |
$66K |
| D4910 |
|
875 |
875 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
793 |
478 |
$53K |
| D9430 |
|
1,329 |
1,241 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,535 |
2,511 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
730 |
464 |
$39K |
| D4341 |
|
467 |
132 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,534 |
1,524 |
$30K |
| D0330 |
Panoramic radiographic image |
1,019 |
1,015 |
$29K |
| D0350 |
|
2,351 |
1,249 |
$22K |
| D2140 |
|
240 |
140 |
$13K |
| D2160 |
|
141 |
102 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
93 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
651 |
631 |
$8K |
| D2330 |
|
66 |
41 |
$5K |
| D4342 |
|
76 |
24 |
$3K |
| D7111 |
|
52 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
193 |
193 |
$2K |
| D2332 |
|
16 |
13 |
$1K |
| D1310 |
|
26 |
26 |
$1K |
| D1320 |
|
58 |
58 |
$785.00 |
| D9993 |
|
12 |
12 |
$0.00 |