| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
713 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
506 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
302 |
146 |
$4K |
| D1110 |
Prophylaxis - adult |
288 |
288 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
203 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
98 |
$1K |
| D1206 |
Topical application of fluoride varnish |
495 |
494 |
$1K |
| D1320 |
|
521 |
520 |
$950.00 |
| D1120 |
Prophylaxis - child |
232 |
232 |
$920.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
790 |
188 |
$873.00 |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
335 |
$741.00 |
| D4341 |
|
38 |
13 |
$720.00 |
| D1354 |
|
1,975 |
172 |
$552.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
66 |
$392.00 |
| D1355 |
|
2,122 |
94 |
$380.00 |
| D0274 |
Bitewings - four radiographic images |
120 |
120 |
$348.00 |
| D0270 |
|
75 |
74 |
$121.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$81.00 |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$52.00 |
| D1330 |
|
882 |
874 |
$40.00 |
| D1310 |
|
868 |
859 |
$0.00 |
| D0602 |
|
56 |
56 |
$0.00 |
| D0601 |
|
282 |
281 |
$0.00 |
| D0603 |
|
329 |
328 |
$0.00 |