| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,605 |
1,577 |
$94K |
| D1110 |
Prophylaxis - adult |
768 |
757 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,221 |
1,195 |
$52K |
| D9430 |
|
1,546 |
1,340 |
$48K |
| D0350 |
|
5,373 |
1,281 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
810 |
806 |
$43K |
| D1120 |
Prophylaxis - child |
716 |
702 |
$25K |
| D0330 |
Panoramic radiographic image |
1,132 |
1,113 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,901 |
1,870 |
$21K |
| D9110 |
|
167 |
150 |
$10K |
| D4910 |
|
130 |
129 |
$10K |
| D0274 |
Bitewings - four radiographic images |
511 |
511 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
59 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,967 |
875 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
98 |
$4K |
| D4341 |
|
48 |
15 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
122 |
25 |
$3K |
| D1320 |
|
12 |
12 |
$100.00 |
| D1310 |
|
44 |
44 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |