| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,425 |
4,396 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,611 |
1,333 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
4,034 |
4,006 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,654 |
1,250 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
2,969 |
2,957 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,418 |
678 |
$165K |
| D1110 |
Prophylaxis - adult |
1,541 |
1,530 |
$127K |
| D1120 |
Prophylaxis - child |
2,723 |
2,711 |
$102K |
| D4341 |
|
1,416 |
513 |
$98K |
| D9430 |
|
2,989 |
2,911 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,756 |
3,737 |
$45K |
| D0350 |
|
4,440 |
1,650 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,363 |
3,157 |
$42K |
| D0330 |
Panoramic radiographic image |
1,323 |
1,321 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,422 |
1,400 |
$17K |
| D4910 |
|
171 |
171 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,085 |
1,076 |
$13K |
| D1206 |
Topical application of fluoride varnish |
497 |
496 |
$7K |
| D0270 |
|
502 |
496 |
$2K |
| D2330 |
|
25 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |