| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
293 |
287 |
$15K |
| D1110 |
Prophylaxis - adult |
257 |
253 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
341 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
85 |
$4K |
| D1120 |
Prophylaxis - child |
62 |
62 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
14 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
39 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
121 |
118 |
$3K |
| D1206 |
Topical application of fluoride varnish |
71 |
71 |
$2K |
| D0330 |
Panoramic radiographic image |
88 |
87 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
94 |
$425.50 |
| D0274 |
Bitewings - four radiographic images |
67 |
67 |
$345.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
29 |
$79.35 |