| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,897 |
3,881 |
$223K |
| D1110 |
Prophylaxis - adult |
2,381 |
2,363 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,432 |
1,492 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,898 |
1,883 |
$120K |
| D1120 |
Prophylaxis - child |
2,709 |
2,698 |
$106K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
222 |
155 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,628 |
1,614 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,671 |
5,638 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,280 |
768 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
809 |
577 |
$64K |
| D0350 |
|
3,043 |
2,774 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,776 |
2,768 |
$53K |
| D4341 |
|
493 |
204 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,265 |
3,489 |
$26K |
| D4910 |
|
275 |
274 |
$21K |
| D4342 |
|
451 |
182 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
37 |
32 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
143 |
$17K |
| D9430 |
|
169 |
165 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
398 |
$5K |
| D2330 |
|
30 |
15 |
$2K |
| D9993 |
|
24 |
24 |
$2K |
| D1310 |
|
24 |
24 |
$1K |
| D0270 |
|
12 |
12 |
$60.00 |