| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,589 |
1,472 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,127 |
1,044 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,927 |
1,800 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
682 |
331 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
268 |
146 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
292 |
162 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
410 |
$12K |
| D1110 |
Prophylaxis - adult |
301 |
291 |
$11K |
| D0330 |
Panoramic radiographic image |
196 |
189 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
307 |
290 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
712 |
645 |
$4K |
| D0274 |
Bitewings - four radiographic images |
155 |
148 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
55 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
129 |
126 |
$2K |
| D1120 |
Prophylaxis - child |
33 |
33 |
$2K |