| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,115 |
4,109 |
$143K |
| D4346 |
|
1,162 |
1,157 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,253 |
617 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
866 |
479 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,183 |
1,132 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
491 |
247 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,946 |
1,896 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,689 |
1,687 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,774 |
2,740 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
271 |
83 |
$18K |
| D1110 |
Prophylaxis - adult |
327 |
327 |
$15K |
| D9110 |
|
263 |
262 |
$15K |
| D4341 |
|
86 |
39 |
$11K |
| D2394 |
|
87 |
54 |
$9K |
| D0330 |
Panoramic radiographic image |
193 |
193 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
325 |
247 |
$3K |
| D0270 |
|
198 |
196 |
$2K |
| D0272 |
Bitewings - two radiographic images |
83 |
83 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$813.47 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$286.86 |