| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
494 |
$16K |
| D1110 |
Prophylaxis - adult |
354 |
354 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
708 |
707 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
41 |
$11K |
| D0274 |
Bitewings - four radiographic images |
377 |
377 |
$10K |
| D1120 |
Prophylaxis - child |
327 |
327 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
761 |
757 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
857 |
649 |
$8K |
| D0330 |
Panoramic radiographic image |
122 |
122 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
250 |
250 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
35 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
138 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
31 |
$3K |
| D0272 |
Bitewings - two radiographic images |
173 |
173 |
$3K |
| D1351 |
Sealant - per tooth |
115 |
31 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |