| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,254 |
1,202 |
$29K |
| D1110 |
Prophylaxis - adult |
648 |
630 |
$24K |
| D0330 |
Panoramic radiographic image |
566 |
547 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
279 |
145 |
$18K |
| D1120 |
Prophylaxis - child |
412 |
400 |
$17K |
| D0274 |
Bitewings - four radiographic images |
836 |
800 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
90 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
420 |
$6K |
| D2335 |
|
73 |
41 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
620 |
524 |
$4K |
| D7310 |
|
44 |
32 |
$3K |
| D2332 |
|
19 |
12 |
$988.68 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$699.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
90 |
$698.90 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
15 |
$694.42 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$441.20 |
| D9110 |
|
21 |
18 |
$439.32 |