| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,374 |
2,349 |
$139K |
| D1110 |
Prophylaxis - adult |
1,730 |
1,716 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
1,574 |
1,574 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,367 |
1,362 |
$51K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
98 |
92 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
591 |
408 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
339 |
122 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,207 |
1,800 |
$25K |
| D1120 |
Prophylaxis - child |
758 |
758 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,880 |
1,807 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
386 |
205 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
232 |
103 |
$13K |
| D0274 |
Bitewings - four radiographic images |
580 |
580 |
$12K |
| D3221 |
|
143 |
128 |
$9K |
| D0330 |
Panoramic radiographic image |
313 |
308 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
53 |
$5K |
| D2330 |
|
67 |
28 |
$5K |
| D3320 |
|
12 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$448.00 |
| D9310 |
|
17 |
17 |
$0.00 |