| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
358 |
332 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
493 |
480 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
551 |
513 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
87 |
$18K |
| D1110 |
Prophylaxis - adult |
396 |
381 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
415 |
$14K |
| D0274 |
Bitewings - four radiographic images |
419 |
407 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
23 |
20 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
38 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
43 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
550 |
524 |
$6K |
| D2950 |
|
33 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
102 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D9110 |
|
24 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$156.24 |
| D1120 |
Prophylaxis - child |
104 |
104 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
132 |
132 |
$0.00 |