| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,573 |
2,528 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
3,718 |
3,561 |
$84K |
| D4355 |
|
1,449 |
1,437 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,646 |
2,817 |
$69K |
| D1110 |
Prophylaxis - adult |
1,759 |
1,742 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,691 |
1,671 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
940 |
537 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,731 |
1,715 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,943 |
3,811 |
$35K |
| D1120 |
Prophylaxis - child |
558 |
556 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
724 |
720 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
128 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
78 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
39 |
$3K |
| D2332 |
|
15 |
12 |
$855.33 |