| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,330 |
1,326 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
889 |
346 |
$59K |
| D1110 |
Prophylaxis - adult |
657 |
656 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,083 |
1,080 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
385 |
224 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
703 |
301 |
$38K |
| D9430 |
|
880 |
820 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
464 |
464 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,340 |
1,330 |
$14K |
| D0330 |
Panoramic radiographic image |
758 |
756 |
$14K |
| D1120 |
Prophylaxis - child |
487 |
485 |
$14K |
| D2335 |
|
113 |
22 |
$13K |
| D0350 |
|
1,123 |
560 |
$13K |
| D2330 |
|
120 |
59 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
33 |
$6K |
| D4341 |
|
58 |
15 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
604 |
317 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
129 |
128 |
$1K |
| D2394 |
|
17 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
68 |
15 |
$1K |