| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,676 |
1,645 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,693 |
2,626 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,302 |
670 |
$63K |
| D1110 |
Prophylaxis - adult |
1,678 |
1,658 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,686 |
2,660 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,742 |
1,669 |
$39K |
| D1351 |
Sealant - per tooth |
1,363 |
192 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,482 |
1,452 |
$30K |
| D4355 |
|
277 |
274 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,060 |
1,045 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
229 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
245 |
181 |
$17K |
| D0330 |
Panoramic radiographic image |
432 |
421 |
$16K |
| D1120 |
Prophylaxis - child |
571 |
568 |
$15K |
| D2330 |
|
247 |
168 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
181 |
132 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
712 |
667 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
24 |
$4K |
| D2140 |
|
39 |
24 |
$1K |
| D2331 |
|
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
216 |
122 |
$947.71 |
| D0272 |
Bitewings - two radiographic images |
52 |
52 |
$736.96 |