| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,218 |
1,217 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,381 |
526 |
$74K |
| D1110 |
Prophylaxis - adult |
815 |
814 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
930 |
930 |
$70K |
| D1120 |
Prophylaxis - child |
1,193 |
1,188 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,087 |
1,749 |
$39K |
| D4910 |
|
475 |
474 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,168 |
2,166 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
411 |
208 |
$27K |
| D9430 |
|
702 |
658 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
396 |
396 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,363 |
1,361 |
$16K |
| D0350 |
|
1,334 |
397 |
$13K |
| D4341 |
|
181 |
50 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
697 |
661 |
$8K |
| D0330 |
Panoramic radiographic image |
69 |
69 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |