| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,017 |
1,921 |
$106K |
| D1110 |
Prophylaxis - adult |
1,950 |
1,859 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,440 |
2,301 |
$96K |
| D0274 |
Bitewings - four radiographic images |
1,997 |
1,878 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
324 |
129 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,345 |
1,274 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
316 |
159 |
$27K |
| D0330 |
Panoramic radiographic image |
623 |
555 |
$20K |
| D7240 |
Removal of impacted tooth - completely bony |
34 |
12 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
226 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
454 |
427 |
$9K |
| D1206 |
Topical application of fluoride varnish |
195 |
185 |
$4K |
| D1120 |
Prophylaxis - child |
113 |
110 |
$4K |
| D4346 |
|
13 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
15 |
$165.65 |