| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,218 |
1,196 |
$79K |
| D1110 |
Prophylaxis - adult |
650 |
649 |
$57K |
| D1120 |
Prophylaxis - child |
951 |
940 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
777 |
772 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
634 |
$30K |
| D9430 |
|
866 |
794 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,378 |
1,364 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,358 |
957 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
113 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
781 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
94 |
$9K |
| D0274 |
Bitewings - four radiographic images |
426 |
416 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
42 |
$8K |
| D0272 |
Bitewings - two radiographic images |
273 |
151 |
$2K |
| D1330 |
|
20 |
20 |
$0.00 |