| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
1,042 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
878 |
871 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
422 |
$33K |
| D1110 |
Prophylaxis - adult |
373 |
373 |
$31K |
| D1120 |
Prophylaxis - child |
538 |
537 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
164 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,380 |
771 |
$14K |
| D1206 |
Topical application of fluoride varnish |
899 |
890 |
$14K |
| D1320 |
|
811 |
802 |
$10K |
| D0272 |
Bitewings - two radiographic images |
495 |
494 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
65 |
$6K |
| D9430 |
|
212 |
198 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |