| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
341 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
74 |
$13K |
| D0330 |
Panoramic radiographic image |
300 |
249 |
$11K |
| D1110 |
Prophylaxis - adult |
421 |
328 |
$11K |
| D0274 |
Bitewings - four radiographic images |
350 |
289 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
50 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
234 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
474 |
373 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
415 |
258 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
77 |
$3K |
| D4355 |
|
35 |
33 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
60 |
59 |
$899.75 |
| D1120 |
Prophylaxis - child |
27 |
27 |
$672.62 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$193.49 |