| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,242 |
942 |
$21K |
| D1120 |
Prophylaxis - child |
577 |
447 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
840 |
639 |
$17K |
| D1110 |
Prophylaxis - adult |
452 |
352 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,052 |
807 |
$11K |
| D0330 |
Panoramic radiographic image |
761 |
587 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
377 |
297 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
40 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
36 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
251 |
$4K |
| D9110 |
|
89 |
74 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
583 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
117 |
$2K |
| D1351 |
Sealant - per tooth |
61 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$722.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
257 |
139 |
$689.70 |
| D0272 |
Bitewings - two radiographic images |
38 |
27 |
$244.40 |