| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
572 |
$33K |
| D1110 |
Prophylaxis - adult |
453 |
453 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
495 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
396 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,024 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
750 |
692 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
278 |
277 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
179 |
179 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
15 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
109 |
109 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |