| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,446 |
3,424 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,236 |
3,217 |
$93K |
| D1110 |
Prophylaxis - adult |
1,841 |
1,834 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
657 |
393 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
533 |
331 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
435 |
186 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
961 |
929 |
$28K |
| D0330 |
Panoramic radiographic image |
640 |
637 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
42 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,009 |
979 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
86 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
352 |
348 |
$6K |
| D4346 |
|
49 |
49 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
210 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
42 |
$1K |