| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,253 |
9,237 |
$318K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,682 |
2,269 |
$265K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,942 |
1,847 |
$258K |
| D0274 |
Bitewings - four radiographic images |
5,626 |
5,611 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
5,057 |
4,972 |
$144K |
| D1110 |
Prophylaxis - adult |
3,138 |
3,135 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,513 |
1,504 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,023 |
2,007 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,840 |
5,835 |
$102K |
| D1120 |
Prophylaxis - child |
2,535 |
2,533 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,573 |
6,482 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
345 |
263 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
160 |
$17K |
| D0330 |
Panoramic radiographic image |
216 |
216 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
294 |
294 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
324 |
316 |
$3K |
| D4341 |
|
24 |
12 |
$3K |
| D0270 |
|
29 |
29 |
$298.28 |