| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,666 |
1,655 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,185 |
1,177 |
$48K |
| D1110 |
Prophylaxis - adult |
611 |
608 |
$48K |
| D0350 |
|
5,189 |
1,422 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
420 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
180 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,960 |
1,008 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
145 |
68 |
$13K |
| D9430 |
|
449 |
421 |
$13K |
| D1120 |
Prophylaxis - child |
268 |
266 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
835 |
832 |
$12K |
| D0274 |
Bitewings - four radiographic images |
737 |
732 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$3K |
| D4341 |
|
39 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
128 |
128 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
352 |
$2K |
| D4910 |
|
24 |
24 |
$1K |
| D1320 |
|
58 |
58 |
$770.00 |