| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,282 |
2,274 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
1,305 |
1,297 |
$61K |
| D0350 |
|
1,679 |
1,502 |
$52K |
| D9430 |
|
1,557 |
1,333 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,921 |
1,730 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
250 |
$28K |
| D0274 |
Bitewings - four radiographic images |
680 |
680 |
$15K |
| D1110 |
Prophylaxis - adult |
163 |
163 |
$14K |
| D0330 |
Panoramic radiographic image |
415 |
415 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
489 |
429 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
49 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
173 |
173 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
151 |
151 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$1K |
| D0270 |
|
253 |
253 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |