| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,707 |
1,704 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,225 |
673 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,259 |
1,257 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
984 |
518 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
985 |
979 |
$51K |
| D1110 |
Prophylaxis - adult |
679 |
673 |
$49K |
| D9430 |
|
1,306 |
1,221 |
$40K |
| D0350 |
|
3,789 |
1,431 |
$34K |
| D1120 |
Prophylaxis - child |
821 |
812 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
257 |
157 |
$28K |
| D4910 |
|
341 |
341 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,885 |
1,875 |
$22K |
| D0274 |
Bitewings - four radiographic images |
995 |
989 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,797 |
2,234 |
$19K |
| D4341 |
|
229 |
66 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
874 |
$10K |
| D3221 |
|
156 |
122 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
34 |
$4K |
| D2140 |
|
28 |
14 |
$1K |
| D1351 |
Sealant - per tooth |
101 |
13 |
$638.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$324.00 |
| D1330 |
|
29 |
27 |
$0.00 |