| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,077 |
$138K |
| D1110 |
Prophylaxis - adult |
1,381 |
1,367 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,171 |
749 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,520 |
1,505 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
899 |
603 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
868 |
373 |
$48K |
| D1120 |
Prophylaxis - child |
885 |
871 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
643 |
642 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
206 |
116 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,354 |
1,354 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,030 |
1,025 |
$20K |
| D9430 |
|
642 |
608 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,578 |
1,544 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
727 |
703 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
14 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
574 |
$7K |
| D2331 |
|
59 |
50 |
$5K |
| D4910 |
|
47 |
47 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
37 |
$3K |
| D2332 |
|
19 |
12 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
33 |
28 |
$396.00 |
| D0270 |
|
46 |
44 |
$225.00 |
| D1706 |
|
13 |
13 |
$0.00 |