| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,244 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
820 |
818 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
556 |
296 |
$37K |
| D1110 |
Prophylaxis - adult |
410 |
410 |
$35K |
| D1120 |
Prophylaxis - child |
604 |
602 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
76 |
$14K |
| D1351 |
Sealant - per tooth |
376 |
100 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,829 |
528 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
580 |
579 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
137 |
136 |
$10K |
| D4342 |
|
95 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
38 |
$3K |
| D0274 |
Bitewings - four radiographic images |
119 |
119 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
144 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
29 |
$2K |
| D1310 |
|
26 |
26 |
$1K |
| D0350 |
|
66 |
51 |
$585.60 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D9993 |
|
25 |
25 |
$0.00 |