| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,569 |
2,109 |
$63K |
| D1120 |
Prophylaxis - child |
1,614 |
1,344 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,249 |
1,029 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,545 |
490 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,581 |
1,314 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,758 |
1,499 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
974 |
840 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,321 |
1,954 |
$20K |
| D1351 |
Sealant - per tooth |
1,024 |
195 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
399 |
166 |
$17K |
| D1110 |
Prophylaxis - adult |
918 |
766 |
$15K |
| D0330 |
Panoramic radiographic image |
527 |
399 |
$13K |
| D2140 |
|
319 |
127 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
145 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,477 |
1,882 |
$11K |
| D0350 |
|
910 |
670 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
652 |
517 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
82 |
$6K |
| D2160 |
|
64 |
27 |
$2K |
| D0601 |
|
533 |
395 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
20 |
$1K |
| D4355 |
|
96 |
45 |
$980.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
28 |
28 |
$840.00 |
| D0160 |
|
99 |
55 |
$775.00 |
| D7111 |
|
29 |
14 |
$713.00 |
| D0170 |
|
64 |
45 |
$608.52 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$300.00 |
| D9210 |
|
102 |
58 |
$266.50 |
| D5211 |
|
22 |
12 |
$205.00 |
| D9310 |
|
198 |
119 |
$40.00 |
| D0191 |
|
41 |
21 |
$30.72 |
| D9215 |
|
233 |
151 |
$24.60 |