| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
542 |
$27K |
| D1110 |
Prophylaxis - adult |
482 |
467 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
104 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
258 |
258 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
576 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
893 |
819 |
$8K |
| D1120 |
Prophylaxis - child |
183 |
183 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
289 |
285 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
585 |
$6K |
| D0272 |
Bitewings - two radiographic images |
366 |
360 |
$6K |
| D0274 |
Bitewings - four radiographic images |
233 |
224 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
25 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
54 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |