| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
884 |
840 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
498 |
482 |
$21K |
| D1120 |
Prophylaxis - child |
694 |
678 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,588 |
1,091 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
70 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
448 |
$14K |
| D1351 |
Sealant - per tooth |
646 |
171 |
$13K |
| D0330 |
Panoramic radiographic image |
544 |
499 |
$13K |
| D4341 |
|
194 |
51 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
127 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
847 |
827 |
$7K |
| D9430 |
|
269 |
227 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
48 |
$5K |
| D0272 |
Bitewings - two radiographic images |
427 |
414 |
$5K |
| D0350 |
|
614 |
298 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
31 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
246 |
235 |
$3K |
| D0274 |
Bitewings - four radiographic images |
131 |
128 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$520.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$0.00 |