| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
990 |
958 |
$30K |
| D1110 |
Prophylaxis - adult |
1,032 |
1,002 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
319 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,721 |
1,650 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
322 |
169 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
427 |
232 |
$14K |
| D1120 |
Prophylaxis - child |
459 |
444 |
$13K |
| D4341 |
|
181 |
67 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
311 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
384 |
380 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
358 |
347 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
422 |
409 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
873 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
704 |
576 |
$2K |
| D9920 |
|
39 |
37 |
$700.00 |
| D0272 |
Bitewings - two radiographic images |
61 |
59 |
$420.00 |
| D1330 |
|
1,511 |
1,423 |
$0.00 |
| D1203 |
|
13 |
13 |
$0.00 |