| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,479 |
1,470 |
$90K |
| D1110 |
Prophylaxis - adult |
544 |
540 |
$45K |
| D9430 |
|
860 |
755 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
578 |
575 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
206 |
130 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
120 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
279 |
111 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,143 |
1,138 |
$15K |
| D0330 |
Panoramic radiographic image |
522 |
521 |
$14K |
| D0350 |
|
630 |
508 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
159 |
159 |
$8K |
| D4341 |
|
46 |
12 |
$3K |
| D1320 |
|
156 |
156 |
$3K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
116 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D3221 |
|
12 |
12 |
$756.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
55 |
$392.85 |