| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
393 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
142 |
$3K |
| D1120 |
Prophylaxis - child |
271 |
267 |
$2K |
| D0274 |
Bitewings - four radiographic images |
289 |
289 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
607 |
605 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
257 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
124 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
683 |
444 |
$1K |
| D1110 |
Prophylaxis - adult |
131 |
131 |
$1K |
| D1206 |
Topical application of fluoride varnish |
270 |
265 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
300 |
295 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
65 |
$840.00 |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$540.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
44 |
$400.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$361.00 |
| D0601 |
|
61 |
59 |
$187.00 |
| D1330 |
|
317 |
311 |
$110.00 |
| D0191 |
|
15 |
15 |
$90.00 |
| D0602 |
|
33 |
33 |
$77.00 |
| D0270 |
|
27 |
26 |
$33.00 |
| D1310 |
|
70 |
70 |
$0.00 |
| D9986 |
|
251 |
245 |
$0.00 |