| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,706 |
1,700 |
$102K |
| D4341 |
|
1,548 |
486 |
$101K |
| D1110 |
Prophylaxis - adult |
1,297 |
1,289 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,074 |
2,066 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
708 |
376 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,707 |
1,702 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,121 |
665 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,177 |
2,226 |
$49K |
| D1120 |
Prophylaxis - child |
1,608 |
1,599 |
$48K |
| D4910 |
|
488 |
488 |
$37K |
| D2140 |
|
651 |
404 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,954 |
2,932 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,398 |
1,391 |
$29K |
| D2160 |
|
225 |
170 |
$18K |
| D1351 |
Sealant - per tooth |
846 |
222 |
$17K |
| D0350 |
|
1,676 |
815 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
96 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
119 |
$10K |
| D9430 |
|
294 |
285 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
359 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
29 |
$4K |
| D4342 |
|
50 |
25 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
101 |
101 |
$1K |