| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,219 |
3,200 |
$206K |
| D1110 |
Prophylaxis - adult |
1,959 |
1,950 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
1,961 |
1,947 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
1,558 |
1,552 |
$84K |
| D1120 |
Prophylaxis - child |
1,295 |
1,295 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,414 |
3,399 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
331 |
217 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,391 |
1,387 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,304 |
2,361 |
$17K |
| D9430 |
|
503 |
481 |
$16K |
| D1320 |
|
986 |
981 |
$15K |
| D0330 |
Panoramic radiographic image |
428 |
428 |
$13K |
| D2160 |
|
146 |
100 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
853 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
41 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
14 |
$1K |
| D0602 |
|
14 |
14 |
$0.00 |