| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,882 |
1,875 |
$66K |
| D4346 |
|
481 |
479 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
447 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
625 |
330 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
671 |
669 |
$38K |
| D0274 |
Bitewings - four radiographic images |
736 |
735 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
527 |
520 |
$16K |
| D1110 |
Prophylaxis - adult |
338 |
338 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
926 |
905 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
94 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
15 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
40 |
$5K |
| D9110 |
|
29 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
64 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
13 |
$176.63 |