| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
583 |
387 |
$24K |
| D1110 |
Prophylaxis - adult |
373 |
270 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
135 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
140 |
70 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
25 |
$7K |
| D0274 |
Bitewings - four radiographic images |
126 |
85 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
42 |
$1K |