| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,576 |
2,565 |
$75K |
| D1110 |
Prophylaxis - adult |
2,034 |
2,018 |
$64K |
| D1206 |
Topical application of fluoride varnish |
5,084 |
5,034 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,459 |
1,454 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
585 |
295 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
707 |
559 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,118 |
1,099 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,390 |
3,291 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,170 |
1,155 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
924 |
$15K |
| D4341 |
|
205 |
115 |
$15K |
| D1351 |
Sealant - per tooth |
1,036 |
333 |
$15K |
| D0603 |
|
4,267 |
4,169 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,696 |
1,719 |
$11K |
| D4346 |
|
118 |
118 |
$9K |
| D0191 |
|
1,499 |
1,472 |
$8K |
| D4342 |
|
166 |
102 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
125 |
$5K |
| D4910 |
|
195 |
191 |
$5K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$2K |
| D0330 |
Panoramic radiographic image |
145 |
145 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$1K |
| D0602 |
|
84 |
81 |
$410.00 |
| D0270 |
|
52 |
52 |
$261.00 |
| D0601 |
|
15 |
15 |
$60.00 |