| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,960 |
2,895 |
$81K |
| D0330 |
Panoramic radiographic image |
1,727 |
1,700 |
$76K |
| D5110 |
|
102 |
101 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
774 |
760 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,209 |
454 |
$43K |
| D1110 |
Prophylaxis - adult |
869 |
853 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
512 |
314 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
667 |
637 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
237 |
$18K |
| D5120 |
|
25 |
25 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,376 |
1,309 |
$10K |
| D0274 |
Bitewings - four radiographic images |
390 |
387 |
$10K |
| D1120 |
Prophylaxis - child |
157 |
148 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
37 |
$3K |
| D1206 |
Topical application of fluoride varnish |
194 |
193 |
$3K |
| D2332 |
|
47 |
29 |
$3K |
| D2335 |
|
33 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
122 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
113 |
$2K |
| D2331 |
|
16 |
13 |
$790.20 |
| D2330 |
|
18 |
12 |
$690.80 |