| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
11,751 |
3,372 |
$133K |
| D1110 |
Prophylaxis - adult |
3,304 |
3,084 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
2,384 |
2,136 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,967 |
2,794 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
4,282 |
3,763 |
$60K |
| D0330 |
Panoramic radiographic image |
849 |
754 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,233 |
1,150 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
686 |
616 |
$25K |
| D5110 |
|
25 |
25 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
131 |
$9K |
| D4355 |
|
130 |
124 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
63 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
68 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
39 |
$7K |
| D1120 |
Prophylaxis - child |
199 |
188 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
164 |
$3K |
| D1351 |
Sealant - per tooth |
59 |
12 |
$1K |