| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
933 |
924 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,147 |
1,134 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
861 |
855 |
$38K |
| D1120 |
Prophylaxis - child |
815 |
806 |
$26K |
| D9430 |
|
769 |
675 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,879 |
1,084 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
129 |
$15K |
| D0274 |
Bitewings - four radiographic images |
796 |
784 |
$12K |
| D0350 |
|
1,480 |
562 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,022 |
1,013 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
76 |
$8K |
| D1110 |
Prophylaxis - adult |
106 |
102 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
24 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
454 |
453 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$472.00 |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$423.00 |