| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,246 |
1,139 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,230 |
418 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,426 |
1,266 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,023 |
948 |
$27K |
| D1120 |
Prophylaxis - child |
637 |
590 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,709 |
1,560 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
309 |
105 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
401 |
127 |
$14K |
| D1206 |
Topical application of fluoride varnish |
444 |
411 |
$14K |
| D0274 |
Bitewings - four radiographic images |
571 |
521 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
59 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
409 |
382 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,254 |
1,076 |
$7K |
| D1351 |
Sealant - per tooth |
281 |
53 |
$6K |
| D0270 |
|
578 |
517 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
43 |
$4K |
| D2160 |
|
26 |
12 |
$2K |
| D2140 |
|
27 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
66 |
$634.88 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$494.88 |
| D1110 |
Prophylaxis - adult |
14 |
13 |
$465.00 |