| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
796 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
145 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
208 |
111 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
138 |
$17K |
| D0274 |
Bitewings - four radiographic images |
412 |
402 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
101 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
656 |
641 |
$14K |
| D1110 |
Prophylaxis - adult |
355 |
343 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
22 |
$13K |
| D0330 |
Panoramic radiographic image |
253 |
211 |
$12K |
| D1120 |
Prophylaxis - child |
266 |
262 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
287 |
273 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
131 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
582 |
553 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
539 |
365 |
$6K |
| D2335 |
|
16 |
13 |
$2K |