| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,227 |
1,224 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
956 |
954 |
$68K |
| D1110 |
Prophylaxis - adult |
714 |
709 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
862 |
294 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
818 |
815 |
$38K |
| D1120 |
Prophylaxis - child |
685 |
682 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
239 |
114 |
$27K |
| D0350 |
|
2,706 |
727 |
$23K |
| D0274 |
Bitewings - four radiographic images |
957 |
953 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
844 |
838 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
99 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,866 |
1,039 |
$8K |
| D4341 |
|
102 |
37 |
$8K |
| D1206 |
Topical application of fluoride varnish |
447 |
444 |
$7K |
| D9430 |
|
195 |
186 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
39 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
475 |
470 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
34 |
$4K |
| D4910 |
|
38 |
38 |
$3K |
| D2394 |
|
30 |
28 |
$2K |
| D2140 |
|
42 |
18 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$520.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$368.81 |
| D0270 |
|
13 |
13 |
$65.00 |