| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,548 |
1,515 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,989 |
1,824 |
$56K |
| D1110 |
Prophylaxis - adult |
1,197 |
1,043 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
531 |
138 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
139 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
164 |
157 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
36 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
510 |
352 |
$3K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$3K |
| D0274 |
Bitewings - four radiographic images |
206 |
133 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
475 |
189 |
$1K |
| D1206 |
Topical application of fluoride varnish |
55 |
53 |
$993.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$525.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$250.25 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$195.00 |
| D9986 |
|
33 |
32 |
$96.00 |
| D9987 |
|
28 |
28 |
$81.00 |
| D9995 |
|
116 |
83 |
$0.00 |
| D0603 |
|
34 |
32 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |
| D0350 |
|
127 |
79 |
$0.00 |
| D9996 |
|
13 |
13 |
$0.00 |