| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,927 |
1,922 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
994 |
989 |
$46K |
| D0350 |
|
1,269 |
1,094 |
$38K |
| D9430 |
|
920 |
811 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,286 |
1,233 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
204 |
96 |
$23K |
| D1110 |
Prophylaxis - adult |
244 |
244 |
$21K |
| D0330 |
Panoramic radiographic image |
658 |
658 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
131 |
$16K |
| D1206 |
Topical application of fluoride varnish |
519 |
519 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
108 |
108 |
$8K |
| D0274 |
Bitewings - four radiographic images |
351 |
351 |
$7K |
| D4341 |
|
38 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
156 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$873.60 |
| D1320 |
|
12 |
12 |
$202.50 |
| D1330 |
|
14 |
14 |
$0.00 |