| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,313 |
$86K |
| D1110 |
Prophylaxis - adult |
671 |
670 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
866 |
492 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,106 |
1,106 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
305 |
162 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
565 |
300 |
$31K |
| D4341 |
|
376 |
100 |
$26K |
| D9430 |
|
731 |
612 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
175 |
$20K |
| D1120 |
Prophylaxis - child |
453 |
453 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
937 |
937 |
$11K |
| D0350 |
|
601 |
292 |
$6K |
| D4342 |
|
117 |
33 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
520 |
306 |
$4K |
| D9993 |
|
60 |
60 |
$4K |
| D4910 |
|
47 |
47 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
38 |
$3K |
| D1310 |
|
61 |
61 |
$3K |
| D1206 |
Topical application of fluoride varnish |
157 |
157 |
$2K |
| D2330 |
|
30 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
106 |
34 |
$2K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
103 |
$1K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$1K |
| D0601 |
|
61 |
61 |
$870.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$675.00 |
| D1354 |
|
16 |
16 |
$420.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
15 |
$168.00 |