| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,127 |
2,123 |
$136K |
| D0210 |
Intraoral - complete series of radiographic images |
1,596 |
1,593 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
746 |
746 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,565 |
1,599 |
$31K |
| D1120 |
Prophylaxis - child |
790 |
790 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
203 |
121 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
157 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,256 |
1,256 |
$15K |
| D0274 |
Bitewings - four radiographic images |
721 |
720 |
$15K |
| D9430 |
|
143 |
131 |
$4K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$3K |
| D0330 |
Panoramic radiographic image |
95 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
76 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$117.00 |