| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,693 |
1,403 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,652 |
1,390 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,129 |
917 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
360 |
196 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
463 |
255 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
228 |
131 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
875 |
702 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
74 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
635 |
$8K |
| D0274 |
Bitewings - four radiographic images |
144 |
126 |
$4K |
| D2394 |
|
19 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
39 |
$1K |
| D0272 |
Bitewings - two radiographic images |
68 |
63 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
24 |
$991.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$257.01 |
| D1999 |
|
78 |
60 |
$0.00 |