| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,818 |
3,801 |
$252K |
| D1110 |
Prophylaxis - adult |
2,637 |
2,627 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
2,681 |
2,668 |
$128K |
| D1120 |
Prophylaxis - child |
2,318 |
2,305 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
1,352 |
1,345 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
503 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,062 |
5,035 |
$77K |
| D0330 |
Panoramic radiographic image |
2,062 |
2,049 |
$61K |
| D1351 |
Sealant - per tooth |
1,612 |
307 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
451 |
194 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,933 |
2,445 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
602 |
324 |
$48K |
| D9430 |
|
1,413 |
1,335 |
$45K |
| D4910 |
|
547 |
547 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,251 |
$27K |
| D4341 |
|
328 |
87 |
$23K |
| D1310 |
|
331 |
330 |
$15K |
| D9993 |
|
288 |
288 |
$4K |
| D0272 |
Bitewings - two radiographic images |
285 |
284 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$2K |
| D2394 |
|
16 |
12 |
$1K |
| D0601 |
|
63 |
63 |
$928.50 |
| D1330 |
|
3,877 |
3,864 |
$0.00 |