| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,556 |
5,502 |
$367K |
| D0210 |
Intraoral - complete series of radiographic images |
4,478 |
4,430 |
$214K |
| D4341 |
|
2,830 |
751 |
$198K |
| D0350 |
|
15,058 |
3,750 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
1,861 |
1,848 |
$124K |
| D1110 |
Prophylaxis - adult |
1,268 |
1,261 |
$113K |
| D1120 |
Prophylaxis - child |
2,204 |
2,190 |
$105K |
| D4910 |
|
1,000 |
998 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
620 |
117 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,471 |
4,439 |
$67K |
| D9430 |
|
1,938 |
1,748 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,702 |
2,688 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,201 |
3,541 |
$49K |
| D4342 |
|
876 |
259 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
276 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,104 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
256 |
142 |
$14K |
| D3221 |
|
186 |
148 |
$12K |
| D0272 |
Bitewings - two radiographic images |
376 |
376 |
$4K |