| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,697 |
2,688 |
$170K |
| D0210 |
Intraoral - complete series of radiographic images |
1,592 |
1,584 |
$72K |
| D0350 |
|
3,953 |
1,031 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,065 |
1,671 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
278 |
146 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,250 |
1,243 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
357 |
204 |
$24K |
| D9430 |
|
539 |
503 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
77 |
$13K |
| D1110 |
Prophylaxis - adult |
137 |
137 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
98 |
96 |
$4K |
| D1206 |
Topical application of fluoride varnish |
232 |
228 |
$3K |
| D4341 |
|
38 |
13 |
$3K |
| D1320 |
|
154 |
154 |
$2K |
| D1120 |
Prophylaxis - child |
36 |
34 |
$990.00 |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$930.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$300.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
19 |
$206.00 |
| D0270 |
|
30 |
30 |
$150.00 |