| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,106 |
2,105 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,961 |
1,034 |
$139K |
| D1110 |
Prophylaxis - adult |
1,685 |
1,683 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,425 |
283 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
319 |
212 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,619 |
851 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,429 |
2,428 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
550 |
$15K |
| D1120 |
Prophylaxis - child |
298 |
298 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,040 |
1,040 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
1,004 |
1,004 |
$6K |
| D2332 |
|
17 |
13 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
220 |
220 |
$4K |
| D1351 |
Sealant - per tooth |
136 |
43 |
$3K |
| D2331 |
|
73 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,196 |
1,179 |
$2K |
| D2335 |
|
21 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
546 |
535 |
$2K |
| D2330 |
|
93 |
46 |
$1K |
| D1206 |
Topical application of fluoride varnish |
507 |
507 |
$352.56 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$345.44 |