| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,842 |
2,287 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,147 |
1,142 |
$74K |
| D0350 |
|
8,421 |
2,335 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
611 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,509 |
1,794 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
534 |
532 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
196 |
$22K |
| D1120 |
Prophylaxis - child |
544 |
538 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
305 |
166 |
$20K |
| D1110 |
Prophylaxis - adult |
151 |
149 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,049 |
956 |
$12K |
| D0274 |
Bitewings - four radiographic images |
611 |
607 |
$11K |
| D1206 |
Topical application of fluoride varnish |
622 |
616 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
51 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
12 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
300 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
12 |
$2K |
| D2330 |
|
24 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$168.00 |
| D1330 |
|
929 |
923 |
$0.00 |