| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
746 |
713 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
971 |
920 |
$22K |
| D1110 |
Prophylaxis - adult |
577 |
554 |
$21K |
| D0330 |
Panoramic radiographic image |
372 |
339 |
$20K |
| D0274 |
Bitewings - four radiographic images |
955 |
928 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
190 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
31 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,438 |
1,331 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
93 |
52 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
226 |
218 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
50 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
379 |
199 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$2K |