| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,088 |
3,071 |
$106K |
| D4346 |
|
701 |
699 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,788 |
1,779 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,837 |
3,687 |
$42K |
| D0330 |
Panoramic radiographic image |
805 |
795 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,291 |
2,280 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,591 |
2,398 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
557 |
349 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,186 |
1,171 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
567 |
284 |
$31K |
| D1110 |
Prophylaxis - adult |
663 |
663 |
$30K |
| D4341 |
|
214 |
59 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
185 |
106 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
377 |
366 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
85 |
$11K |
| D2335 |
|
74 |
39 |
$9K |
| D1120 |
Prophylaxis - child |
140 |
140 |
$4K |
| D0270 |
|
89 |
87 |
$882.92 |
| D9110 |
|
14 |
14 |
$778.11 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$240.93 |