| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
829 |
$49K |
| D8670 |
Periodic orthodontic treatment visit |
163 |
163 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
602 |
295 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
501 |
497 |
$23K |
| D0350 |
|
1,943 |
673 |
$19K |
| D2140 |
|
323 |
145 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
73 |
$13K |
| D9430 |
|
373 |
372 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,696 |
783 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
174 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
39 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
89 |
$3K |
| D1120 |
Prophylaxis - child |
96 |
96 |
$3K |
| D1110 |
Prophylaxis - adult |
31 |
29 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$820.80 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$288.00 |