| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,554 |
1,336 |
$52K |
| D1110 |
Prophylaxis - adult |
1,699 |
1,429 |
$52K |
| D0330 |
Panoramic radiographic image |
1,440 |
1,265 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,980 |
1,706 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
271 |
$39K |
| D4355 |
|
501 |
463 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,456 |
2,074 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,532 |
1,911 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
145 |
71 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
71 |
$11K |
| D1206 |
Topical application of fluoride varnish |
992 |
823 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
73 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
404 |
301 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$459.59 |
| D8660 |
|
215 |
204 |
$0.00 |