| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
703 |
692 |
$38K |
| D1110 |
Prophylaxis - adult |
298 |
294 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
830 |
699 |
$11K |
| D0274 |
Bitewings - four radiographic images |
403 |
395 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
37 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
26 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
13 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
37 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$418.00 |