| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
837 |
802 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,390 |
$15K |
| D4341 |
|
385 |
182 |
$9K |
| D1110 |
Prophylaxis - adult |
522 |
499 |
$8K |
| D2750 |
|
38 |
24 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
128 |
$5K |
| D1120 |
Prophylaxis - child |
327 |
317 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
86 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
310 |
288 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
75 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
195 |
189 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
226 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
686 |
638 |
$1K |
| D0274 |
Bitewings - four radiographic images |
137 |
129 |
$692.50 |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
29 |
$665.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
420 |
$555.00 |
| D2950 |
|
20 |
16 |
$530.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$234.00 |
| D0272 |
Bitewings - two radiographic images |
19 |
19 |
$80.00 |
| D1330 |
|
922 |
874 |
$0.00 |
| D9986 |
|
99 |
89 |
$0.00 |