| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,008 |
2,974 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,617 |
1,386 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,464 |
898 |
$75K |
| D1110 |
Prophylaxis - adult |
2,059 |
2,025 |
$53K |
| D0330 |
Panoramic radiographic image |
2,429 |
2,405 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,172 |
482 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,270 |
758 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
430 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,159 |
1,136 |
$22K |
| D0274 |
Bitewings - four radiographic images |
3,233 |
3,198 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
939 |
890 |
$9K |
| D4341 |
|
492 |
146 |
$8K |
| D1206 |
Topical application of fluoride varnish |
2,519 |
2,477 |
$4K |
| D2331 |
|
134 |
90 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
146 |
61 |
$4K |
| D1120 |
Prophylaxis - child |
207 |
205 |
$3K |
| D1330 |
|
2,470 |
2,423 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,759 |
3,610 |
$553.85 |
| D2330 |
|
20 |
14 |
$546.40 |
| D0220 |
Intraoral - periapical first radiographic image |
3,922 |
3,852 |
$412.95 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$72.32 |