| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,588 |
1,583 |
$104K |
| D1110 |
Prophylaxis - adult |
1,178 |
1,171 |
$104K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
158 |
114 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,412 |
1,408 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
363 |
223 |
$42K |
| D4910 |
|
512 |
506 |
$39K |
| D4341 |
|
508 |
143 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
371 |
370 |
$33K |
| D9430 |
|
734 |
718 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
156 |
$22K |
| D0330 |
Panoramic radiographic image |
674 |
670 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,381 |
1,372 |
$20K |
| D0350 |
|
1,466 |
477 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,171 |
840 |
$13K |
| D2954 |
|
121 |
91 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
848 |
800 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
94 |
$10K |
| D2330 |
|
86 |
48 |
$7K |
| D0272 |
Bitewings - two radiographic images |
342 |
341 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$720.00 |