| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,205 |
2,188 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,356 |
726 |
$90K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
530 |
271 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,178 |
1,166 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
911 |
430 |
$49K |
| D9430 |
|
1,259 |
1,100 |
$40K |
| D1110 |
Prophylaxis - adult |
427 |
423 |
$37K |
| D1320 |
|
1,492 |
1,477 |
$23K |
| D0350 |
|
2,115 |
792 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,156 |
1,145 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,399 |
871 |
$11K |
| D0330 |
Panoramic radiographic image |
302 |
299 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
70 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
100 |
99 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
70 |
70 |
$2K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$2K |
| D4342 |
|
41 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |