| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
320 |
$11K |
| D0330 |
Panoramic radiographic image |
198 |
195 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
38 |
$7K |
| D1120 |
Prophylaxis - child |
256 |
244 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
56 |
$5K |
| D0274 |
Bitewings - four radiographic images |
198 |
188 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
178 |
$3K |
| D1206 |
Topical application of fluoride varnish |
167 |
163 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
13 |
$848.88 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$841.96 |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
65 |
$673.56 |
| D9248 |
|
14 |
13 |
$334.23 |