| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,485 |
1,485 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,515 |
1,515 |
$63K |
| D1110 |
Prophylaxis - adult |
830 |
830 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
319 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
108 |
$12K |
| D1206 |
Topical application of fluoride varnish |
480 |
480 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
60 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
281 |
281 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
137 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
16 |
$3K |
| D1120 |
Prophylaxis - child |
80 |
80 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
187 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
177 |
174 |
$2K |