| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,207 |
1,204 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,408 |
350 |
$77K |
| D1110 |
Prophylaxis - adult |
862 |
860 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
853 |
283 |
$57K |
| D9430 |
|
819 |
735 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
261 |
259 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,362 |
1,356 |
$19K |
| D0330 |
Panoramic radiographic image |
646 |
646 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
389 |
$19K |
| D2330 |
|
204 |
69 |
$16K |
| D0350 |
|
428 |
401 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
33 |
$12K |
| D1120 |
Prophylaxis - child |
98 |
95 |
$4K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$1K |