| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,592 |
1,532 |
$81K |
| D1120 |
Prophylaxis - child |
906 |
832 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
738 |
254 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
911 |
252 |
$31K |
| D0160 |
|
1,181 |
953 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
931 |
766 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,430 |
1,390 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
789 |
661 |
$17K |
| D0274 |
Bitewings - four radiographic images |
670 |
651 |
$15K |
| D7220 |
|
103 |
52 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
225 |
177 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
838 |
725 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
501 |
472 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$959.40 |
| D0999 |
Unspecified diagnostic procedure, by report |
22 |
22 |
$660.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$329.43 |
| D1999 |
|
13 |
13 |
$195.00 |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$0.00 |