| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,365 |
1,252 |
$56K |
| D1110 |
Prophylaxis - adult |
1,150 |
1,083 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
967 |
904 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
351 |
190 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
760 |
712 |
$19K |
| D0274 |
Bitewings - four radiographic images |
170 |
160 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
29 |
$5K |
| D0330 |
Panoramic radiographic image |
53 |
52 |
$3K |
| D1120 |
Prophylaxis - child |
38 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$965.43 |
| D0272 |
Bitewings - two radiographic images |
45 |
43 |
$792.91 |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
75 |
$792.77 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$553.56 |
| D1999 |
|
342 |
259 |
$0.02 |