| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,329 |
1,250 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,518 |
1,360 |
$53K |
| D0330 |
Panoramic radiographic image |
1,885 |
1,001 |
$31K |
| D1110 |
Prophylaxis - adult |
1,039 |
567 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
478 |
127 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
76 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
65 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
331 |
187 |
$5K |
| D0274 |
Bitewings - four radiographic images |
188 |
88 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
40 |
$434.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
25 |
$183.40 |