| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,823 |
1,815 |
$119K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
400 |
120 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
1,016 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,104 |
1,396 |
$30K |
| D1110 |
Prophylaxis - adult |
328 |
328 |
$29K |
| D0350 |
|
2,512 |
693 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
253 |
253 |
$19K |
| D0274 |
Bitewings - four radiographic images |
851 |
848 |
$18K |
| D1120 |
Prophylaxis - child |
246 |
246 |
$12K |
| D9430 |
|
375 |
345 |
$12K |
| D1206 |
Topical application of fluoride varnish |
628 |
628 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
54 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
42 |
$4K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D1320 |
|
99 |
99 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
101 |
$1K |
| D0270 |
|
45 |
44 |
$225.00 |