| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
401 |
385 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
421 |
204 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
559 |
283 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
478 |
460 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
114 |
$10K |
| D1110 |
Prophylaxis - adult |
113 |
109 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
45 |
$4K |
| D2394 |
|
38 |
26 |
$2K |
| D2335 |
|
18 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
59 |
59 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
115 |
$667.40 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$518.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$371.25 |