| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,555 |
1,185 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
622 |
306 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,283 |
1,084 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
803 |
632 |
$34K |
| D1110 |
Prophylaxis - adult |
879 |
673 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,939 |
1,504 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
437 |
121 |
$19K |
| D0330 |
Panoramic radiographic image |
762 |
576 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
172 |
77 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,523 |
611 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
99 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
433 |
336 |
$8K |
| D0274 |
Bitewings - four radiographic images |
396 |
325 |
$8K |
| D1206 |
Topical application of fluoride varnish |
538 |
378 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
12 |
$2K |
| D0270 |
|
200 |
161 |
$1K |
| D1120 |
Prophylaxis - child |
68 |
39 |
$939.18 |
| D0272 |
Bitewings - two radiographic images |
35 |
13 |
$251.55 |