| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,258 |
2,065 |
$105K |
| D1110 |
Prophylaxis - adult |
2,683 |
1,800 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,872 |
1,056 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,003 |
812 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
549 |
505 |
$12K |
| D0330 |
Panoramic radiographic image |
354 |
239 |
$10K |
| D1120 |
Prophylaxis - child |
241 |
222 |
$9K |
| D0272 |
Bitewings - two radiographic images |
337 |
306 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
36 |
$5K |
| D0274 |
Bitewings - four radiographic images |
195 |
107 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
125 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
33 |
$810.87 |
| D0999 |
Unspecified diagnostic procedure, by report |
488 |
119 |
$0.00 |