| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,285 |
1,283 |
$77K |
| D1110 |
Prophylaxis - adult |
808 |
803 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
796 |
361 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
899 |
895 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
264 |
$33K |
| D9430 |
|
977 |
888 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
453 |
450 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,515 |
1,506 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
123 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,043 |
991 |
$12K |
| D1120 |
Prophylaxis - child |
375 |
372 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
755 |
733 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
25 |
$5K |
| D2330 |
|
28 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$820.80 |
| D0290 |
|
13 |
13 |
$455.00 |