| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
639 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
66 |
$13K |
| D0330 |
Panoramic radiographic image |
337 |
335 |
$11K |
| D1110 |
Prophylaxis - adult |
226 |
223 |
$7K |
| D0274 |
Bitewings - four radiographic images |
547 |
543 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
231 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
532 |
229 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
287 |
280 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
62 |
$987.04 |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
44 |
$908.00 |
| D0367 |
|
97 |
97 |
$0.00 |
| D1999 |
|
14 |
13 |
$0.00 |