| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,955 |
$126K |
| D9430 |
|
2,258 |
1,723 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
558 |
333 |
$64K |
| D1110 |
Prophylaxis - adult |
540 |
534 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
956 |
952 |
$44K |
| D0330 |
Panoramic radiographic image |
904 |
901 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
133 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
104 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,060 |
731 |
$11K |
| D1206 |
Topical application of fluoride varnish |
552 |
549 |
$8K |
| D1120 |
Prophylaxis - child |
130 |
130 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
90 |
90 |
$6K |
| D0350 |
|
540 |
189 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
371 |
$4K |
| D0274 |
Bitewings - four radiographic images |
232 |
229 |
$4K |
| D4341 |
|
47 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
193 |
176 |
$2K |