| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,554 |
1,317 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,726 |
822 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
573 |
168 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
135 |
$29K |
| D1110 |
Prophylaxis - adult |
839 |
557 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
319 |
247 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
100 |
$2K |
| D1120 |
Prophylaxis - child |
54 |
52 |
$2K |
| D0272 |
Bitewings - two radiographic images |
94 |
90 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
40 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
30 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
54 |
$697.42 |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$573.26 |
| D9986 |
|
24 |
15 |
$0.00 |