| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,062 |
1,059 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,072 |
1,068 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
368 |
176 |
$44K |
| D9430 |
|
953 |
913 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,979 |
1,543 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
658 |
641 |
$8K |
| D0350 |
|
782 |
299 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
167 |
165 |
$6K |
| D4910 |
|
67 |
67 |
$5K |
| D0274 |
Bitewings - four radiographic images |
95 |
91 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
52 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
125 |
$1K |