| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
763 |
$22K |
| D1110 |
Prophylaxis - adult |
442 |
437 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
190 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
88 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
24 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
64 |
$5K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$3K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
64 |
61 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$953.70 |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$769.50 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
102 |
$752.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$193.20 |