| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,900 |
1,898 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
832 |
362 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,655 |
1,653 |
$49K |
| D1110 |
Prophylaxis - adult |
1,021 |
1,021 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,875 |
1,873 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,672 |
2,613 |
$30K |
| D1120 |
Prophylaxis - child |
707 |
706 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,132 |
1,884 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
331 |
144 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
252 |
251 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
111 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
45 |
45 |
$828.79 |