| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,011 |
1,998 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,039 |
3,019 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,176 |
616 |
$48K |
| D1110 |
Prophylaxis - adult |
1,389 |
1,384 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
675 |
506 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,222 |
2,203 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,286 |
1,257 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
259 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,577 |
1,543 |
$13K |
| D4355 |
|
177 |
175 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
543 |
540 |
$10K |
| D0274 |
Bitewings - four radiographic images |
448 |
444 |
$9K |
| D0330 |
Panoramic radiographic image |
234 |
229 |
$8K |
| D0272 |
Bitewings - two radiographic images |
338 |
336 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
57 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
85 |
$678.16 |
| D1120 |
Prophylaxis - child |
26 |
25 |
$542.50 |
| D1330 |
|
1,530 |
1,526 |
$0.00 |