| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,810 |
2,784 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
2,022 |
2,000 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,098 |
2,077 |
$84K |
| D1120 |
Prophylaxis - child |
1,818 |
1,800 |
$64K |
| D9430 |
|
1,749 |
1,663 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
846 |
452 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,246 |
2,761 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
324 |
145 |
$36K |
| D0350 |
|
3,862 |
1,012 |
$35K |
| D1110 |
Prophylaxis - adult |
438 |
428 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,353 |
1,343 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,291 |
1,276 |
$22K |
| D4341 |
|
363 |
108 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
688 |
674 |
$6K |
| D0330 |
Panoramic radiographic image |
315 |
315 |
$6K |
| D1206 |
Topical application of fluoride varnish |
540 |
534 |
$6K |
| D1351 |
Sealant - per tooth |
299 |
70 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
29 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
261 |
259 |
$2K |
| D4910 |
|
30 |
30 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$2K |