| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
793 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
394 |
388 |
$11K |
| D1110 |
Prophylaxis - adult |
482 |
477 |
$10K |
| D1120 |
Prophylaxis - child |
421 |
417 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
249 |
248 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
100 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
68 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
369 |
365 |
$3K |
| D0274 |
Bitewings - four radiographic images |
230 |
229 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
519 |
494 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
734 |
399 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
53 |
$1K |
| D1203 |
|
16 |
16 |
$0.00 |
| D9986 |
|
65 |
63 |
$0.00 |
| D1330 |
|
626 |
618 |
$0.00 |