| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,049 |
1,019 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
598 |
261 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
202 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,137 |
1,087 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
610 |
583 |
$8K |
| D0274 |
Bitewings - four radiographic images |
439 |
418 |
$6K |
| D1110 |
Prophylaxis - adult |
278 |
265 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
138 |
44 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
298 |
289 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
251 |
$3K |
| D1120 |
Prophylaxis - child |
75 |
74 |
$2K |
| D4355 |
|
18 |
18 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$173.29 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
58 |
$142.49 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
16 |
$5.51 |