| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,985 |
1,977 |
$123K |
| D1110 |
Prophylaxis - adult |
1,399 |
1,395 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,654 |
611 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,277 |
553 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,719 |
1,710 |
$79K |
| D9430 |
|
2,054 |
1,764 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
462 |
$27K |
| D0350 |
|
1,452 |
936 |
$23K |
| D2330 |
|
305 |
131 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,678 |
1,673 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
189 |
114 |
$22K |
| D4341 |
|
198 |
58 |
$14K |
| D2332 |
|
151 |
56 |
$13K |
| D0330 |
Panoramic radiographic image |
309 |
309 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
980 |
594 |
$7K |
| D0274 |
Bitewings - four radiographic images |
267 |
267 |
$4K |
| D1120 |
Prophylaxis - child |
95 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
249 |
$3K |
| D1320 |
|
174 |
173 |
$3K |
| D2331 |
|
32 |
13 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
28 |
$2K |
| D4910 |
|
15 |
15 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$203.00 |