| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,111 |
2,804 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,100 |
624 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,687 |
1,593 |
$54K |
| D0330 |
Panoramic radiographic image |
916 |
857 |
$53K |
| D1110 |
Prophylaxis - adult |
1,512 |
1,422 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,223 |
2,119 |
$49K |
| D1120 |
Prophylaxis - child |
1,066 |
1,033 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
798 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,312 |
1,265 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
287 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
356 |
238 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,688 |
2,411 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
82 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,394 |
832 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
283 |
264 |
$14K |
| D1351 |
Sealant - per tooth |
341 |
78 |
$13K |
| D9613 |
|
53 |
41 |
$8K |
| D0191 |
|
81 |
78 |
$2K |
| D2394 |
|
17 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$386.56 |