| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,858 |
1,832 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
1,678 |
1,649 |
$77K |
| D1110 |
Prophylaxis - adult |
766 |
747 |
$60K |
| D9430 |
|
1,469 |
1,317 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
621 |
612 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
398 |
230 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,951 |
1,904 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,334 |
1,686 |
$22K |
| D1120 |
Prophylaxis - child |
615 |
605 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
67 |
$13K |
| D0274 |
Bitewings - four radiographic images |
467 |
460 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
538 |
$7K |
| D0350 |
|
476 |
129 |
$3K |
| D9110 |
|
28 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$928.20 |
| D1999 |
|
616 |
482 |
$220.00 |