| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,017 |
986 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,290 |
2,260 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,080 |
1,051 |
$50K |
| D1120 |
Prophylaxis - child |
1,100 |
1,094 |
$49K |
| D1110 |
Prophylaxis - adult |
1,101 |
1,065 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,515 |
1,485 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
441 |
329 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
526 |
337 |
$35K |
| D0274 |
Bitewings - four radiographic images |
691 |
675 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
668 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,459 |
1,409 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,153 |
917 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
51 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
29 |
$4K |
| D2331 |
|
20 |
13 |
$2K |