| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
284 |
284 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
108 |
$11K |
| D1110 |
Prophylaxis - adult |
308 |
307 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
385 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
104 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
33 |
$7K |
| D0274 |
Bitewings - four radiographic images |
233 |
233 |
$5K |
| D2335 |
|
45 |
26 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
232 |
231 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
246 |
245 |
$4K |
| D1120 |
Prophylaxis - child |
125 |
125 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
89 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
139 |
$695.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
84 |
$465.00 |