| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,527 |
2,521 |
$165K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
859 |
437 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
1,587 |
1,583 |
$74K |
| D0350 |
|
7,579 |
2,052 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
774 |
768 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,725 |
2,516 |
$45K |
| D1110 |
Prophylaxis - adult |
519 |
519 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
346 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,507 |
1,497 |
$30K |
| D9430 |
|
912 |
857 |
$29K |
| D1120 |
Prophylaxis - child |
754 |
754 |
$29K |
| D4341 |
|
397 |
106 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,762 |
1,752 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
177 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
384 |
$4K |
| D4910 |
|
26 |
26 |
$2K |
| D9910 |
|
47 |
45 |
$0.00 |
| D1999 |
|
16 |
15 |
$0.00 |