| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,199 |
1,082 |
$36K |
| D1351 |
Sealant - per tooth |
1,457 |
193 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
416 |
156 |
$25K |
| D1120 |
Prophylaxis - child |
429 |
395 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
413 |
371 |
$21K |
| D1206 |
Topical application of fluoride varnish |
432 |
398 |
$21K |
| D0330 |
Panoramic radiographic image |
399 |
369 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
524 |
$9K |
| D5214 |
|
25 |
16 |
$7K |
| D0274 |
Bitewings - four radiographic images |
345 |
315 |
$7K |
| D5110 |
|
22 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,010 |
559 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
48 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
156 |
147 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
42 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
60 |
$2K |
| D4355 |
|
44 |
25 |
$1K |
| D0270 |
|
112 |
107 |
$1K |
| D5820 |
|
20 |
14 |
$820.00 |
| D0603 |
|
179 |
167 |
$700.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$559.65 |
| D0350 |
|
31 |
29 |
$553.50 |
| D7311 |
|
69 |
39 |
$434.60 |
| D1110 |
Prophylaxis - adult |
18 |
15 |
$300.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$275.73 |
| D0601 |
|
54 |
51 |
$220.00 |