| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,229 |
1,229 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,143 |
1,143 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
443 |
255 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
400 |
242 |
$22K |
| D4341 |
|
272 |
105 |
$19K |
| D1110 |
Prophylaxis - adult |
174 |
174 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
85 |
39 |
$10K |
| D0350 |
|
616 |
210 |
$6K |
| D1206 |
Topical application of fluoride varnish |
315 |
315 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
83 |
$1K |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$561.60 |
| D1330 |
|
243 |
243 |
$0.00 |