| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
649 |
526 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
916 |
732 |
$27K |
| D1110 |
Prophylaxis - adult |
645 |
537 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
236 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
440 |
382 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
54 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
597 |
476 |
$6K |
| D0274 |
Bitewings - four radiographic images |
180 |
155 |
$5K |
| D1206 |
Topical application of fluoride varnish |
332 |
279 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
362 |
189 |
$3K |
| D1120 |
Prophylaxis - child |
65 |
52 |
$1K |
| D0270 |
|
42 |
38 |
$760.91 |