| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,231 |
1,117 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
558 |
283 |
$25K |
| D1110 |
Prophylaxis - adult |
590 |
535 |
$22K |
| D0330 |
Panoramic radiographic image |
494 |
422 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
210 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
321 |
150 |
$12K |
| D0274 |
Bitewings - four radiographic images |
387 |
355 |
$9K |
| D2335 |
|
105 |
53 |
$8K |
| D7250 |
|
79 |
37 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
79 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
474 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
120 |
$4K |
| D2332 |
|
67 |
28 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
59 |
$3K |
| D2331 |
|
44 |
21 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$1K |
| D9110 |
|
51 |
48 |
$1K |
| D0160 |
|
37 |
16 |
$491.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
42 |
$371.43 |