| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,183 |
2,171 |
$144K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
850 |
466 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,822 |
1,810 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,475 |
522 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
995 |
990 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
938 |
428 |
$63K |
| D1120 |
Prophylaxis - child |
1,254 |
1,247 |
$56K |
| D1110 |
Prophylaxis - adult |
618 |
614 |
$54K |
| D9430 |
|
1,030 |
1,014 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,815 |
1,807 |
$26K |
| D0350 |
|
1,875 |
645 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,478 |
1,170 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
878 |
848 |
$10K |
| D0330 |
Panoramic radiographic image |
204 |
204 |
$6K |
| D4341 |
|
43 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$1K |