| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
206 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
190 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
29 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
317 |
281 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
312 |
128 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
51 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
24 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
29 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
44 |
$1K |
| D1120 |
Prophylaxis - child |
17 |
17 |
$766.18 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$390.00 |