| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,071 |
2,008 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,577 |
2,479 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,691 |
581 |
$64K |
| D1120 |
Prophylaxis - child |
1,425 |
1,372 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
878 |
361 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,250 |
1,212 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,216 |
135 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,088 |
3,002 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,582 |
1,542 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,399 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,341 |
2,256 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
907 |
863 |
$24K |
| D1110 |
Prophylaxis - adult |
472 |
452 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
53 |
$8K |
| D0272 |
Bitewings - two radiographic images |
295 |
284 |
$5K |
| D1351 |
Sealant - per tooth |
221 |
41 |
$5K |
| D4355 |
|
286 |
213 |
$4K |
| D3120 |
|
261 |
64 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
139 |
134 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$390.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$240.00 |
| D0601 |
|
15 |
15 |
$70.00 |
| D1999 |
|
21 |
19 |
$0.00 |