| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,486 |
1,390 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
81 |
75 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
387 |
242 |
$27K |
| D0330 |
Panoramic radiographic image |
927 |
858 |
$26K |
| D1110 |
Prophylaxis - adult |
765 |
710 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
344 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
956 |
902 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
107 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
256 |
130 |
$13K |
| D1120 |
Prophylaxis - child |
474 |
455 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
439 |
419 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
49 |
$7K |
| D2950 |
|
65 |
60 |
$7K |
| D1351 |
Sealant - per tooth |
312 |
48 |
$7K |
| D0274 |
Bitewings - four radiographic images |
447 |
414 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
592 |
567 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
560 |
345 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
230 |
217 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
69 |
51 |
$1K |
| D0272 |
Bitewings - two radiographic images |
62 |
62 |
$901.38 |
| D0270 |
|
90 |
89 |
$661.25 |
| D4355 |
|
13 |
12 |
$506.61 |