| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,524 |
1,523 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,067 |
269 |
$163K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,246 |
757 |
$88K |
| D1110 |
Prophylaxis - adult |
1,980 |
1,978 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,415 |
245 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
166 |
$33K |
| D0330 |
Panoramic radiographic image |
2,081 |
2,079 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,235 |
1,229 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
719 |
473 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,231 |
2,228 |
$8K |
| D4341 |
|
63 |
27 |
$4K |
| D0274 |
Bitewings - four radiographic images |
2,201 |
2,199 |
$775.57 |
| D0120 |
Periodic oral evaluation - established patient |
93 |
93 |
$150.81 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,405 |
1,405 |
$40.65 |
| D0220 |
Intraoral - periapical first radiographic image |
1,207 |
1,194 |
$35.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
294 |
284 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$0.00 |