| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
666 |
652 |
$30K |
| D1110 |
Prophylaxis - adult |
788 |
775 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
822 |
810 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
162 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
468 |
453 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
309 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
50 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
485 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
269 |
267 |
$4K |
| D1120 |
Prophylaxis - child |
134 |
134 |
$4K |
| D0274 |
Bitewings - four radiographic images |
123 |
121 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
177 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$576.20 |