| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
924 |
640 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,133 |
762 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,112 |
818 |
$14K |
| D0330 |
Panoramic radiographic image |
980 |
814 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,115 |
829 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
382 |
272 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,287 |
432 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,855 |
1,377 |
$754.84 |
| D0272 |
Bitewings - two radiographic images |
103 |
61 |
$601.05 |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
50 |
$332.64 |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
59 |
$87.92 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,075 |
1,179 |
$0.00 |
| D0602 |
|
44 |
25 |
$0.00 |
| D1999 |
|
626 |
420 |
$0.00 |
| D0431 |
|
22 |
13 |
$0.00 |