| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,823 |
2,646 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,157 |
1,071 |
$61K |
| D1110 |
Prophylaxis - adult |
906 |
847 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,021 |
451 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,066 |
998 |
$16K |
| D1120 |
Prophylaxis - child |
325 |
304 |
$15K |
| D1351 |
Sealant - per tooth |
306 |
64 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
545 |
509 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
41 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
38 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
51 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
33 |
$1K |
| D9110 |
|
42 |
39 |
$890.82 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$734.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
84 |
$705.60 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$194.60 |