| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,195 |
$77K |
| D9430 |
|
1,589 |
1,387 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,034 |
1,030 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
264 |
259 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
877 |
865 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,939 |
1,097 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
612 |
583 |
$7K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$4K |
| D1120 |
Prophylaxis - child |
136 |
135 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
27 |
$4K |
| D4341 |
|
47 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
166 |
162 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
16 |
$2K |