| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,212 |
4,022 |
$109K |
| D1110 |
Prophylaxis - adult |
2,018 |
1,928 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,459 |
1,364 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
787 |
560 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,235 |
1,217 |
$36K |
| D0330 |
Panoramic radiographic image |
615 |
604 |
$32K |
| D1120 |
Prophylaxis - child |
613 |
580 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,544 |
1,466 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
518 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
515 |
279 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
423 |
339 |
$18K |
| D9110 |
|
582 |
533 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
139 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,410 |
1,363 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
162 |
$11K |
| D2140 |
|
163 |
120 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
229 |
228 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
130 |
$1K |
| D2331 |
|
18 |
12 |
$913.00 |