| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
468 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
173 |
85 |
$19K |
| D0330 |
Panoramic radiographic image |
506 |
458 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
452 |
382 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
112 |
$14K |
| D1110 |
Prophylaxis - adult |
199 |
187 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
376 |
$9K |
| D0274 |
Bitewings - four radiographic images |
412 |
376 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
316 |
$4K |
| D4346 |
|
25 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
37 |
37 |
$1K |
| D4341 |
|
22 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
181 |
69 |
$313.47 |