| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,097 |
2,057 |
$35K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,693 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,079 |
1,075 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
868 |
865 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,443 |
1,439 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
412 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
569 |
370 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
238 |
$10K |
| D0274 |
Bitewings - four radiographic images |
818 |
818 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,980 |
1,944 |
$7K |
| D1120 |
Prophylaxis - child |
369 |
369 |
$6K |
| D4341 |
|
43 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
72 |
72 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
112 |
112 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
257 |
241 |
$970.25 |
| D0270 |
|
175 |
174 |
$511.00 |
| D4355 |
|
12 |
12 |
$450.00 |