| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,911 |
1,881 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,439 |
1,421 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,086 |
1,055 |
$41K |
| D1110 |
Prophylaxis - adult |
437 |
435 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
259 |
149 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
207 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,995 |
1,833 |
$20K |
| D0274 |
Bitewings - four radiographic images |
945 |
934 |
$16K |
| D4341 |
|
260 |
91 |
$16K |
| D9430 |
|
460 |
426 |
$14K |
| D1120 |
Prophylaxis - child |
404 |
389 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
577 |
565 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
58 |
$7K |
| D0350 |
|
332 |
95 |
$3K |
| D1320 |
|
155 |
152 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
15 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$310.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$216.00 |
| D1330 |
|
79 |
68 |
$0.00 |