| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,949 |
1,480 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,877 |
1,069 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
297 |
$20K |
| D9110 |
|
249 |
240 |
$16K |
| D1110 |
Prophylaxis - adult |
167 |
167 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
654 |
653 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
98 |
98 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
13 |
$5K |
| D1120 |
Prophylaxis - child |
132 |
132 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$820.80 |
| D9430 |
|
14 |
13 |
$448.00 |