| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
733 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
382 |
167 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
183 |
72 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
282 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
35 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
153 |
$6K |
| D1351 |
Sealant - per tooth |
335 |
67 |
$6K |
| D0274 |
Bitewings - four radiographic images |
283 |
267 |
$5K |
| D1110 |
Prophylaxis - adult |
110 |
106 |
$4K |
| D1120 |
Prophylaxis - child |
198 |
190 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
136 |
$2K |
| D2394 |
|
16 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
39 |
$887.31 |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
80 |
$713.92 |
| D1206 |
Topical application of fluoride varnish |
44 |
42 |
$534.98 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$177.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$86.93 |