| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,855 |
1,766 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
661 |
612 |
$34K |
| D1110 |
Prophylaxis - adult |
465 |
431 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
493 |
232 |
$18K |
| D1120 |
Prophylaxis - child |
247 |
230 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
690 |
656 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
291 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D2332 |
|
20 |
13 |
$1K |
| D2140 |
|
19 |
16 |
$814.72 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$793.23 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$699.26 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$642.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
27 |
$292.50 |
| D9110 |
|
12 |
12 |
$257.63 |