| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,414 |
1,387 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
602 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
41 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
660 |
638 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
59 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
200 |
$6K |
| D1110 |
Prophylaxis - adult |
126 |
126 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
39 |
$4K |
| D0274 |
Bitewings - four radiographic images |
126 |
124 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$225.19 |