| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
573 |
$13K |
| D4341 |
|
57 |
28 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
54 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
338 |
$9K |
| D1120 |
Prophylaxis - child |
223 |
210 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
44 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
121 |
107 |
$3K |
| D1110 |
Prophylaxis - adult |
56 |
54 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
94 |
$2K |
| D0330 |
Panoramic radiographic image |
91 |
82 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
63 |
$380.80 |
| D0274 |
Bitewings - four radiographic images |
16 |
12 |
$253.50 |
| D0270 |
|
13 |
12 |
$61.60 |