| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
8,406 |
1,484 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
873 |
873 |
$58K |
| D1110 |
Prophylaxis - adult |
526 |
526 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
637 |
637 |
$31K |
| D1120 |
Prophylaxis - child |
286 |
286 |
$15K |
| D4341 |
|
200 |
51 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
826 |
826 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
102 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
95 |
$11K |
| D1320 |
|
619 |
618 |
$11K |
| D9430 |
|
290 |
248 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
18 |
18 |
$9K |
| D4910 |
|
90 |
90 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,581 |
291 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
61 |
$6K |
| D0274 |
Bitewings - four radiographic images |
151 |
151 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
29 |
$3K |
| D2954 |
|
15 |
15 |
$2K |
| D2140 |
|
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
93 |
84 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$640.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$540.00 |