| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
991 |
972 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,406 |
1,291 |
$43K |
| D1110 |
Prophylaxis - adult |
844 |
776 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
298 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
491 |
291 |
$35K |
| D4341 |
|
198 |
83 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
64 |
$12K |
| D1120 |
Prophylaxis - child |
344 |
338 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
387 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
468 |
449 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
731 |
$8K |
| D0274 |
Bitewings - four radiographic images |
342 |
334 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
387 |
373 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
544 |
425 |
$6K |
| D4342 |
|
26 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$314.40 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |