| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
560 |
549 |
$8K |
| D1110 |
Prophylaxis - adult |
336 |
332 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
317 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
422 |
409 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
44 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
26 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
165 |
161 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
329 |
135 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
27 |
15 |
$0.00 |
| D2950 |
|
15 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$0.00 |