| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
32,809 |
7,878 |
$311K |
| D1110 |
Prophylaxis - adult |
3,266 |
3,263 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
3,140 |
3,135 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,097 |
3,093 |
$204K |
| D1120 |
Prophylaxis - child |
2,589 |
2,587 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,682 |
1,218 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,882 |
1,882 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,570 |
968 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,479 |
5,473 |
$75K |
| D9430 |
|
2,179 |
2,089 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,439 |
3,435 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,069 |
6,136 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
1,767 |
1,720 |
$21K |
| D9110 |
|
314 |
307 |
$20K |
| D2330 |
|
203 |
112 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
131 |
$15K |
| D1206 |
Topical application of fluoride varnish |
784 |
784 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$2K |
| D1310 |
|
37 |
37 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$1K |
| D0602 |
|
36 |
36 |
$525.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$324.00 |
| D0270 |
|
30 |
30 |
$150.00 |