| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,815 |
$62K |
| D1110 |
Prophylaxis - adult |
790 |
789 |
$35K |
| D0330 |
Panoramic radiographic image |
420 |
419 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
268 |
145 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
321 |
150 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
338 |
335 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
420 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
577 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
95 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
57 |
57 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$386.31 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
26 |
$374.24 |