| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,500 |
1,455 |
$89K |
| D1110 |
Prophylaxis - adult |
1,743 |
1,716 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,631 |
1,585 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,171 |
2,139 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,643 |
1,622 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,615 |
1,587 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,045 |
1,026 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
440 |
214 |
$23K |
| D1120 |
Prophylaxis - child |
1,072 |
1,052 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
52 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,211 |
1,171 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
50 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
527 |
324 |
$2K |
| D2394 |
|
31 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
109 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
193 |
191 |
$2K |
| D1320 |
|
62 |
62 |
$976.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$911.53 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$680.96 |