| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,220 |
3,208 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
2,374 |
2,370 |
$112K |
| D9430 |
|
3,325 |
2,708 |
$102K |
| D1110 |
Prophylaxis - adult |
692 |
689 |
$61K |
| D4341 |
|
637 |
186 |
$45K |
| D4910 |
|
570 |
569 |
$42K |
| D0350 |
|
5,024 |
1,386 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
603 |
288 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
425 |
425 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
239 |
93 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
490 |
196 |
$27K |
| D2332 |
|
263 |
35 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
231 |
95 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,170 |
1,235 |
$17K |
| D1206 |
Topical application of fluoride varnish |
968 |
964 |
$16K |
| D0330 |
Panoramic radiographic image |
492 |
489 |
$14K |
| D0274 |
Bitewings - four radiographic images |
344 |
344 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
301 |
289 |
$4K |
| D1120 |
Prophylaxis - child |
80 |
78 |
$3K |
| D0270 |
|
26 |
24 |
$125.00 |