| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,475 |
3,108 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,259 |
1,242 |
$73K |
| D1120 |
Prophylaxis - child |
1,392 |
1,358 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,362 |
2,271 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,424 |
1,389 |
$49K |
| D1351 |
Sealant - per tooth |
1,673 |
242 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,695 |
2,763 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,581 |
1,546 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,322 |
2,213 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
952 |
934 |
$28K |
| D1110 |
Prophylaxis - adult |
1,272 |
1,250 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
274 |
97 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
32 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
13 |
$2K |
| D1353 |
|
55 |
12 |
$705.20 |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$453.64 |
| D0999 |
Unspecified diagnostic procedure, by report |
15 |
15 |
$450.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$240.00 |
| D0603 |
|
49 |
49 |
$214.75 |
| D0601 |
|
56 |
55 |
$211.25 |
| D0602 |
|
59 |
59 |
$162.00 |