| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,803 |
2,793 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,362 |
1,245 |
$156K |
| D1110 |
Prophylaxis - adult |
1,750 |
1,746 |
$150K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
300 |
233 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
1,938 |
1,925 |
$124K |
| D1120 |
Prophylaxis - child |
2,165 |
2,152 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,643 |
848 |
$88K |
| D0350 |
|
10,284 |
3,656 |
$85K |
| D9430 |
|
1,971 |
1,769 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
469 |
273 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,654 |
4,433 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,739 |
3,716 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,155 |
1,150 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,510 |
2,499 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
611 |
309 |
$48K |
| D4341 |
|
575 |
163 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,041 |
1,894 |
$21K |
| D2330 |
|
144 |
56 |
$11K |
| D1351 |
Sealant - per tooth |
264 |
83 |
$6K |
| D4910 |
|
56 |
56 |
$4K |
| D0272 |
Bitewings - two radiographic images |
268 |
268 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
27 |
$3K |
| D1206 |
Topical application of fluoride varnish |
151 |
151 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$2K |
| D1999 |
|
80 |
73 |
$0.00 |