| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,483 |
2,466 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
2,215 |
2,158 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,520 |
1,517 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,717 |
3,629 |
$68K |
| D1120 |
Prophylaxis - child |
1,508 |
1,479 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
422 |
216 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,074 |
2,061 |
$38K |
| D0350 |
|
3,491 |
1,000 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,032 |
2,011 |
$26K |
| D1110 |
Prophylaxis - adult |
286 |
286 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
36 |
28 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
47 |
$7K |
| D4341 |
|
124 |
41 |
$7K |
| D0330 |
Panoramic radiographic image |
347 |
347 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
52 |
$6K |
| D1351 |
Sealant - per tooth |
156 |
28 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
29 |
$4K |
| D9430 |
|
121 |
119 |
$4K |
| D0272 |
Bitewings - two radiographic images |
162 |
158 |
$2K |
| D9993 |
|
36 |
30 |
$2K |
| D1310 |
|
34 |
30 |
$1K |
| D9110 |
|
12 |
12 |
$756.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$311.00 |
| D1330 |
|
258 |
202 |
$0.00 |