| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,027 |
3,009 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,691 |
1,307 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
2,335 |
2,319 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,952 |
895 |
$104K |
| D1110 |
Prophylaxis - adult |
1,211 |
1,205 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
1,442 |
1,433 |
$100K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
792 |
433 |
$92K |
| D1120 |
Prophylaxis - child |
1,555 |
1,546 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,469 |
2,610 |
$54K |
| D0350 |
|
4,046 |
1,561 |
$42K |
| D9430 |
|
1,206 |
1,129 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,671 |
1,662 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,562 |
2,550 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
198 |
$26K |
| D4910 |
|
317 |
317 |
$24K |
| D0330 |
Panoramic radiographic image |
314 |
313 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
306 |
304 |
$4K |
| D0340 |
|
74 |
74 |
$4K |
| D1351 |
Sealant - per tooth |
86 |
24 |
$3K |
| D3221 |
|
34 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
12 |
$2K |
| D1320 |
|
60 |
60 |
$550.00 |
| D1999 |
|
135 |
129 |
$260.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$168.00 |
| D1310 |
|
85 |
85 |
$0.00 |
| D1330 |
|
91 |
91 |
$0.00 |