| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,562 |
2,554 |
$169K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
260 |
234 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,903 |
2,122 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
352 |
195 |
$42K |
| D9430 |
|
1,248 |
1,182 |
$40K |
| D1110 |
Prophylaxis - adult |
415 |
411 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
422 |
415 |
$33K |
| D1120 |
Prophylaxis - child |
651 |
639 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
613 |
607 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,358 |
1,352 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,467 |
1,452 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
83 |
$16K |
| D0330 |
Panoramic radiographic image |
437 |
435 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
86 |
$13K |
| D0350 |
|
826 |
212 |
$7K |
| D3348 |
|
13 |
13 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
73 |
$876.00 |
| D0272 |
Bitewings - two radiographic images |
60 |
60 |
$708.00 |
| D1310 |
|
13 |
13 |
$598.00 |
| D9993 |
|
13 |
13 |
$0.00 |