| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
11,741 |
6,145 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,121 |
3,112 |
$1K |
| D1110 |
Prophylaxis - adult |
6,350 |
6,310 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
6,539 |
6,406 |
$492.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,656 |
4,625 |
$250.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
63 |
$156.00 |
| D0330 |
Panoramic radiographic image |
3,033 |
3,023 |
$102.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,215 |
839 |
$80.00 |
| D0274 |
Bitewings - four radiographic images |
3,524 |
3,495 |
$72.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
972 |
518 |
$60.00 |
| D0140 |
Limited oral evaluation - problem focused |
626 |
470 |
$50.00 |
| D0170 |
|
1,279 |
1,197 |
$25.00 |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
68 |
$18.00 |
| D1120 |
Prophylaxis - child |
136 |
134 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
28 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,811 |
2,793 |
$0.00 |
| D2330 |
|
117 |
81 |
$0.00 |
| D7250 |
|
34 |
14 |
$0.00 |