| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,483 |
3,455 |
$119K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,061 |
690 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,938 |
3,905 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,712 |
3,637 |
$108K |
| D1110 |
Prophylaxis - adult |
2,481 |
2,461 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
7,948 |
7,742 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,840 |
4,803 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,412 |
781 |
$77K |
| D0330 |
Panoramic radiographic image |
1,907 |
1,886 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
769 |
485 |
$55K |
| D2950 |
|
438 |
388 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,258 |
4,944 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
83 |
76 |
$37K |
| D1120 |
Prophylaxis - child |
964 |
959 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
57 |
56 |
$29K |
| D0270 |
|
1,371 |
1,362 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
661 |
656 |
$13K |
| D4346 |
|
82 |
82 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
77 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
32 |
32 |
$629.32 |