| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,237 |
2,215 |
$53K |
| D1110 |
Prophylaxis - adult |
1,295 |
1,248 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,660 |
1,617 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
897 |
873 |
$27K |
| D5110 |
|
13 |
13 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
100 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
106 |
$8K |
| D1120 |
Prophylaxis - child |
133 |
133 |
$5K |
| D0274 |
Bitewings - four radiographic images |
190 |
183 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
244 |
233 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
25 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
96 |
$1K |
| D5410 |
|
13 |
12 |
$441.00 |