| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,668 |
1,649 |
$109K |
| D1110 |
Prophylaxis - adult |
1,270 |
1,255 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,458 |
1,442 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
876 |
498 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,043 |
561 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
658 |
653 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,024 |
2,007 |
$26K |
| D1120 |
Prophylaxis - child |
545 |
533 |
$21K |
| D0350 |
|
1,641 |
638 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
150 |
103 |
$17K |
| D2330 |
|
181 |
105 |
$14K |
| D0274 |
Bitewings - four radiographic images |
395 |
391 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,571 |
618 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
37 |
$3K |
| D5750 |
|
13 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
14 |
$2K |
| D9110 |
|
12 |
12 |
$630.00 |