| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
642 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
154 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
345 |
343 |
$17K |
| D1110 |
Prophylaxis - adult |
279 |
278 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
95 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
225 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
61 |
$7K |
| D0330 |
Panoramic radiographic image |
221 |
218 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
451 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,450 |
293 |
$4K |
| D0274 |
Bitewings - four radiographic images |
248 |
245 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$2K |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$938.32 |
| D0270 |
|
88 |
88 |
$848.88 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$753.24 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$159.60 |