| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,829 |
1,768 |
$43K |
| D1110 |
Prophylaxis - adult |
1,225 |
1,175 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
608 |
293 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,332 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
424 |
174 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
356 |
340 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,833 |
1,363 |
$13K |
| D1120 |
Prophylaxis - child |
643 |
614 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
801 |
772 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
118 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
673 |
651 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
115 |
$9K |
| D0330 |
Panoramic radiographic image |
180 |
175 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,552 |
1,460 |
$7K |
| D0272 |
Bitewings - two radiographic images |
428 |
411 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
127 |
$3K |