| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
493 |
457 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
550 |
536 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
62 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
39 |
$6K |
| D1110 |
Prophylaxis - adult |
130 |
126 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
144 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
27 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
101 |
101 |
$1K |
| D1120 |
Prophylaxis - child |
60 |
60 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
128 |
128 |
$884.80 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$572.80 |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$407.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
40 |
$275.80 |