| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,215 |
2,215 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,119 |
1,119 |
$47K |
| D1110 |
Prophylaxis - adult |
979 |
979 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
619 |
348 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,213 |
1,213 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,614 |
1,611 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
650 |
650 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,195 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
63 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
389 |
388 |
$5K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$1K |