| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
852 |
847 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
989 |
989 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
964 |
713 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
433 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
613 |
599 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
150 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,088 |
1,073 |
$4K |
| D0274 |
Bitewings - four radiographic images |
707 |
707 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,445 |
558 |
$3K |
| D0603 |
|
681 |
674 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
132 |
$2K |
| D1206 |
Topical application of fluoride varnish |
415 |
414 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
739 |
$2K |
| D0602 |
|
291 |
291 |
$1K |
| D0270 |
|
290 |
285 |
$1K |
| D1120 |
Prophylaxis - child |
54 |
54 |
$720.00 |
| D1110 |
Prophylaxis - adult |
62 |
62 |
$705.00 |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$156.00 |
| D1310 |
|
525 |
516 |
$40.00 |
| D1330 |
|
685 |
672 |
$30.00 |