| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,418 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,077 |
1,035 |
$28K |
| D1110 |
Prophylaxis - adult |
1,151 |
1,121 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
587 |
331 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
679 |
$17K |
| D1120 |
Prophylaxis - child |
520 |
496 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
447 |
433 |
$8K |
| D2750 |
|
18 |
14 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,233 |
1,192 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
457 |
406 |
$4K |
| D0274 |
Bitewings - four radiographic images |
570 |
556 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
70 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,869 |
798 |
$4K |
| D4341 |
|
75 |
28 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
27 |
$2K |
| D9920 |
|
31 |
31 |
$728.50 |
| D0272 |
Bitewings - two radiographic images |
67 |
62 |
$285.00 |
| D1330 |
|
1,169 |
1,121 |
$0.00 |
| D1203 |
|
24 |
24 |
$0.00 |