| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
524 |
$17K |
| D1110 |
Prophylaxis - adult |
304 |
304 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
715 |
714 |
$12K |
| D1120 |
Prophylaxis - child |
385 |
385 |
$12K |
| D0274 |
Bitewings - four radiographic images |
363 |
363 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
785 |
777 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
781 |
666 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
64 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
235 |
235 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
25 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
151 |
$4K |
| D1351 |
Sealant - per tooth |
183 |
45 |
$4K |
| D0330 |
Panoramic radiographic image |
82 |
81 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
198 |
198 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
15 |
$1K |