| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
362 |
349 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
512 |
$13K |
| D1110 |
Prophylaxis - adult |
343 |
337 |
$12K |
| D1206 |
Topical application of fluoride varnish |
604 |
591 |
$9K |
| D0274 |
Bitewings - four radiographic images |
237 |
224 |
$5K |
| D0330 |
Panoramic radiographic image |
83 |
81 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
31 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
127 |
117 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
175 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
50 |
49 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
75 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
115 |
$876.39 |