| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
1,183 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
334 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
586 |
572 |
$12K |
| D1110 |
Prophylaxis - adult |
709 |
697 |
$11K |
| D1120 |
Prophylaxis - child |
435 |
426 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
340 |
333 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
281 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
118 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
372 |
349 |
$2K |
| D0274 |
Bitewings - four radiographic images |
340 |
329 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
476 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
689 |
674 |
$2K |
| D9920 |
|
95 |
95 |
$1K |
| D1206 |
Topical application of fluoride varnish |
78 |
78 |
$915.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
17 |
$494.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$490.00 |
| D0601 |
|
13 |
13 |
$100.00 |
| D1203 |
|
14 |
14 |
$0.00 |
| D1330 |
|
1,207 |
1,189 |
$0.00 |