| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,488 |
1,366 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
919 |
400 |
$31K |
| D1110 |
Prophylaxis - adult |
873 |
755 |
$28K |
| D0274 |
Bitewings - four radiographic images |
870 |
776 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
205 |
$15K |
| D0330 |
Panoramic radiographic image |
413 |
387 |
$14K |
| D1120 |
Prophylaxis - child |
272 |
256 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
700 |
597 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,040 |
928 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
675 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
37 |
$3K |
| D2335 |
|
22 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$867.00 |
| D0120 |
Periodic oral evaluation - established patient |
32 |
31 |
$610.40 |