| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,552 |
1,550 |
$102K |
| D0350 |
|
6,301 |
1,637 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
945 |
944 |
$45K |
| D9430 |
|
850 |
730 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
278 |
277 |
$22K |
| D0330 |
Panoramic radiographic image |
713 |
712 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
106 |
$17K |
| D1320 |
|
963 |
961 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,145 |
869 |
$13K |
| D1110 |
Prophylaxis - adult |
92 |
92 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
25 |
$5K |
| D0274 |
Bitewings - four radiographic images |
242 |
242 |
$5K |
| D1206 |
Topical application of fluoride varnish |
296 |
295 |
$5K |
| D1120 |
Prophylaxis - child |
85 |
84 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
89 |
89 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$168.00 |