| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,701 |
1,686 |
$58K |
| D1110 |
Prophylaxis - adult |
882 |
875 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
501 |
189 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
460 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
856 |
853 |
$16K |
| D0274 |
Bitewings - four radiographic images |
525 |
522 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,021 |
1,000 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
572 |
559 |
$5K |
| D1120 |
Prophylaxis - child |
168 |
168 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
93 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
19 |
18 |
$382.92 |