| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,624 |
5,278 |
$136K |
| D1120 |
Prophylaxis - child |
3,307 |
3,077 |
$136K |
| D1110 |
Prophylaxis - adult |
3,112 |
2,915 |
$134K |
| D0330 |
Panoramic radiographic image |
3,086 |
2,850 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,409 |
892 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,871 |
2,595 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,438 |
4,145 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,379 |
2,207 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,234 |
1,123 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,392 |
1,276 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,321 |
2,136 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
221 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
49 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
16 |
$293.85 |
| D9986 |
|
827 |
789 |
$0.00 |