| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,072 |
4,972 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,803 |
1,624 |
$139K |
| D0330 |
Panoramic radiographic image |
2,701 |
2,654 |
$126K |
| D1110 |
Prophylaxis - adult |
2,604 |
2,558 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,289 |
925 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,161 |
1,135 |
$30K |
| D1120 |
Prophylaxis - child |
536 |
530 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
544 |
373 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,409 |
1,391 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,652 |
2,584 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,129 |
1,114 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
178 |
$16K |
| D2332 |
|
76 |
56 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
24 |
$3K |
| D2331 |
|
27 |
25 |
$2K |
| D9110 |
|
25 |
24 |
$971.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
71 |
$542.79 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$227.40 |