| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,035 |
$24K |
| D1110 |
Prophylaxis - adult |
580 |
553 |
$21K |
| D1120 |
Prophylaxis - child |
311 |
296 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
149 |
$11K |
| D0330 |
Panoramic radiographic image |
321 |
304 |
$11K |
| D0274 |
Bitewings - four radiographic images |
480 |
449 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
68 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
736 |
678 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
84 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
378 |
$4K |
| D0272 |
Bitewings - two radiographic images |
269 |
256 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
274 |
262 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
30 |
$3K |
| D2331 |
|
15 |
12 |
$728.25 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
24 |
$622.70 |
| D9110 |
|
14 |
13 |
$265.65 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$264.50 |
| D9986 |
|
261 |
215 |
$0.00 |