| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,411 |
1,344 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,783 |
568 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
590 |
166 |
$100K |
| D1351 |
Sealant - per tooth |
4,330 |
544 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,023 |
1,997 |
$94K |
| D1120 |
Prophylaxis - child |
2,873 |
2,152 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,466 |
490 |
$69K |
| D1110 |
Prophylaxis - adult |
1,404 |
943 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,531 |
1,823 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,892 |
1,509 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,387 |
947 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
93 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,265 |
939 |
$20K |
| D0274 |
Bitewings - four radiographic images |
912 |
581 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,428 |
1,485 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
238 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
83 |
15 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,526 |
813 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
26 |
$7K |
| D0330 |
Panoramic radiographic image |
715 |
413 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
114 |
$4K |
| D1999 |
|
1,112 |
660 |
$0.00 |