| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
362 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
314 |
307 |
$21K |
| D1110 |
Prophylaxis - adult |
303 |
294 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
144 |
71 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
171 |
$9K |
| D1330 |
|
163 |
157 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
26 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
100 |
98 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
129 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
58 |
58 |
$2K |