| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,740 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
166 |
$25K |
| D0330 |
Panoramic radiographic image |
584 |
576 |
$25K |
| D1110 |
Prophylaxis - adult |
586 |
574 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
720 |
703 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
186 |
81 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
1,028 |
$21K |
| D9630 |
|
1,147 |
1,134 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
145 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
474 |
468 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
501 |
491 |
$3K |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$435.76 |
| D4341 |
|
111 |
45 |
$0.00 |