| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,182 |
870 |
$35K |
| D0274 |
Bitewings - four radiographic images |
781 |
745 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
159 |
77 |
$19K |
| D1110 |
Prophylaxis - adult |
489 |
462 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
207 |
118 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
722 |
693 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
137 |
$15K |
| D0330 |
Panoramic radiographic image |
253 |
240 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,320 |
758 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
953 |
904 |
$12K |
| D1120 |
Prophylaxis - child |
151 |
150 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
31 |
$858.72 |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$684.60 |