| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,389 |
1,380 |
$91K |
| D9430 |
|
2,107 |
1,619 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,250 |
1,241 |
$59K |
| D1110 |
Prophylaxis - adult |
494 |
489 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
504 |
205 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
154 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
42 |
19 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
176 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
41 |
$13K |
| D1206 |
Topical application of fluoride varnish |
554 |
547 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,133 |
521 |
$5K |
| D0274 |
Bitewings - four radiographic images |
146 |
143 |
$3K |
| D0350 |
|
340 |
104 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$862.50 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$682.50 |