| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,502 |
1,387 |
$70K |
| D1110 |
Prophylaxis - adult |
1,758 |
1,636 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,128 |
289 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,914 |
1,787 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
353 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
87 |
66 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,597 |
1,493 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,083 |
1,017 |
$21K |
| D4341 |
|
164 |
58 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,467 |
1,355 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
67 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
244 |
$7K |
| D4910 |
|
108 |
95 |
$6K |
| D0330 |
Panoramic radiographic image |
1,085 |
996 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
433 |
$4K |
| D2950 |
|
38 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
76 |
73 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
55 |
$828.00 |