| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,154 |
3,146 |
$209K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
548 |
235 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,694 |
1,689 |
$79K |
| D1110 |
Prophylaxis - adult |
604 |
604 |
$53K |
| D0330 |
Panoramic radiographic image |
1,599 |
1,592 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,036 |
1,033 |
$18K |
| D9430 |
|
537 |
504 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
260 |
260 |
$15K |
| D1120 |
Prophylaxis - child |
259 |
258 |
$13K |
| D9420 |
|
15 |
15 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$6K |
| D2160 |
|
45 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
176 |
175 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$3K |
| D0367 |
|
12 |
12 |
$3K |
| D0340 |
|
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
83 |
$736.50 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$152.00 |