| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
512 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
201 |
197 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
84 |
$17K |
| D0330 |
Panoramic radiographic image |
172 |
168 |
$15K |
| D1110 |
Prophylaxis - adult |
211 |
207 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
171 |
$8K |
| D2950 |
|
57 |
45 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
22 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
20 |
$4K |
| D1206 |
Topical application of fluoride varnish |
85 |
84 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
164 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
45 |
44 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$197.11 |