| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,115 |
2,112 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
1,864 |
1,863 |
$77K |
| D4341 |
|
540 |
153 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
575 |
285 |
$33K |
| D9430 |
|
927 |
784 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
520 |
520 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
295 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,086 |
1,755 |
$20K |
| D4910 |
|
241 |
237 |
$16K |
| D1110 |
Prophylaxis - adult |
168 |
166 |
$12K |
| D1120 |
Prophylaxis - child |
272 |
271 |
$10K |
| D0274 |
Bitewings - four radiographic images |
521 |
518 |
$10K |
| D0350 |
|
1,027 |
333 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
892 |
778 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
33 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
47 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
333 |
330 |
$4K |
| D1206 |
Topical application of fluoride varnish |
150 |
150 |
$2K |