| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,368 |
1,357 |
$89K |
| D1110 |
Prophylaxis - adult |
485 |
476 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
890 |
877 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
115 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
163 |
$19K |
| D9951 |
|
359 |
186 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
113 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
90 |
$9K |
| D1206 |
Topical application of fluoride varnish |
412 |
411 |
$6K |
| D1120 |
Prophylaxis - child |
119 |
119 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
538 |
282 |
$3K |
| D0274 |
Bitewings - four radiographic images |
125 |
125 |
$3K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$2K |
| D3221 |
|
31 |
28 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
108 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
95 |
$1K |
| D0350 |
|
54 |
50 |
$652.80 |
| D2940 |
|
19 |
15 |
$63.00 |
| 99070 |
|
17 |
15 |
$2.60 |
| D9910 |
|
28 |
28 |
$0.00 |