| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,522 |
2,168 |
$115K |
| D1110 |
Prophylaxis - adult |
3,951 |
3,453 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,923 |
924 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,703 |
2,126 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,565 |
692 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,405 |
3,145 |
$71K |
| D1120 |
Prophylaxis - child |
1,499 |
1,423 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,801 |
2,592 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,855 |
1,671 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,159 |
1,868 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,418 |
1,228 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
480 |
264 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,223 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
80 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
136 |
41 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D2950 |
|
161 |
65 |
$5K |
| D1351 |
Sealant - per tooth |
109 |
26 |
$4K |
| D2394 |
|
42 |
28 |
$3K |
| D2331 |
|
36 |
25 |
$3K |
| D2140 |
|
23 |
12 |
$1K |
| D0270 |
|
93 |
77 |
$461.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
14 |
$201.28 |