| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,596 |
4,593 |
$159K |
| D4346 |
|
1,316 |
1,314 |
$157K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,343 |
644 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,857 |
1,180 |
$136K |
| D0210 |
Intraoral - complete series of radiographic images |
2,004 |
1,882 |
$104K |
| D9243 |
|
803 |
234 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,293 |
804 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,413 |
2,408 |
$71K |
| D1110 |
Prophylaxis - adult |
1,479 |
1,477 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,121 |
2,072 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,849 |
4,767 |
$55K |
| D9410 |
|
524 |
363 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,788 |
3,022 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,091 |
2,091 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
337 |
264 |
$30K |
| D9239 |
|
234 |
232 |
$29K |
| D4341 |
|
203 |
51 |
$26K |
| D0270 |
|
886 |
880 |
$9K |
| D1120 |
Prophylaxis - child |
241 |
241 |
$7K |
| D1206 |
Topical application of fluoride varnish |
186 |
186 |
$3K |
| D2394 |
|
30 |
25 |
$3K |
| D2335 |
|
24 |
13 |
$3K |
| D2331 |
|
15 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$895.60 |