| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
11,311 |
10,121 |
$458K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,494 |
3,525 |
$412K |
| D1110 |
Prophylaxis - adult |
14,641 |
13,260 |
$376K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,312 |
3,262 |
$292K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,458 |
4,236 |
$243K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,187 |
14,661 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,032 |
2,646 |
$208K |
| D0140 |
Limited oral evaluation - problem focused |
11,718 |
10,609 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,015 |
8,866 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
11,681 |
10,687 |
$171K |
| D0274 |
Bitewings - four radiographic images |
8,109 |
7,381 |
$132K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,233 |
1,885 |
$122K |
| D1120 |
Prophylaxis - child |
5,544 |
5,012 |
$120K |
| D0330 |
Panoramic radiographic image |
3,583 |
3,228 |
$119K |
| D9110 |
|
4,430 |
3,964 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,384 |
1,041 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
8,403 |
7,515 |
$58K |
| D2140 |
|
1,950 |
1,128 |
$56K |
| D4355 |
|
674 |
586 |
$43K |
| D2335 |
|
549 |
358 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,952 |
1,818 |
$26K |
| D2160 |
|
532 |
362 |
$25K |
| D1351 |
Sealant - per tooth |
651 |
143 |
$10K |
| D0270 |
|
1,574 |
1,389 |
$9K |
| D2331 |
|
200 |
118 |
$9K |
| D2330 |
|
224 |
129 |
$8K |
| D7250 |
|
104 |
55 |
$7K |
| D2332 |
|
126 |
83 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,170 |
968 |
$6K |
| D5211 |
|
38 |
12 |
$4K |
| D2394 |
|
26 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
31 |
29 |
$449.25 |