| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,213 |
1,206 |
$73K |
| D9430 |
|
1,625 |
1,515 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
618 |
614 |
$38K |
| D1120 |
Prophylaxis - child |
914 |
913 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
705 |
704 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,920 |
2,079 |
$29K |
| D1110 |
Prophylaxis - adult |
345 |
340 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,902 |
1,891 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
72 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,454 |
1,375 |
$17K |
| D0274 |
Bitewings - four radiographic images |
273 |
273 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
37 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |
| D2140 |
|
23 |
13 |
$1K |