| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,179 |
5,174 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
3,743 |
3,716 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
3,897 |
3,894 |
$184K |
| D0350 |
|
14,968 |
3,749 |
$139K |
| D1120 |
Prophylaxis - child |
3,308 |
3,290 |
$130K |
| D1110 |
Prophylaxis - adult |
1,285 |
1,284 |
$109K |
| D4341 |
|
1,556 |
416 |
$107K |
| D9430 |
|
3,160 |
2,706 |
$100K |
| D4910 |
|
1,233 |
1,232 |
$94K |
| D0274 |
Bitewings - four radiographic images |
4,355 |
4,325 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,694 |
5,666 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
853 |
427 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,583 |
5,978 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
201 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
110 |
28 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,170 |
1,117 |
$13K |
| D4342 |
|
258 |
77 |
$11K |
| D3221 |
|
114 |
99 |
$7K |
| D1351 |
Sealant - per tooth |
250 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
420 |
419 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
40 |
$3K |
| D9920 |
|
30 |
29 |
$3K |
| D7510 |
|
16 |
15 |
$1K |