| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,847 |
1,832 |
$121K |
| D1120 |
Prophylaxis - child |
1,676 |
1,667 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,203 |
1,197 |
$56K |
| D1110 |
Prophylaxis - adult |
561 |
556 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
727 |
406 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,441 |
2,427 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
603 |
603 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
481 |
256 |
$26K |
| D0350 |
|
2,462 |
666 |
$22K |
| D1310 |
|
462 |
462 |
$20K |
| D1351 |
Sealant - per tooth |
400 |
105 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,629 |
1,045 |
$10K |
| D0274 |
Bitewings - four radiographic images |
502 |
501 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
49 |
$7K |
| D1320 |
|
412 |
412 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
133 |
$2K |
| D0601 |
|
115 |
115 |
$2K |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$900.00 |
| D0603 |
|
30 |
30 |
$420.00 |
| D0602 |
|
26 |
26 |
$255.00 |