| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,322 |
2,183 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,149 |
345 |
$59K |
| D1120 |
Prophylaxis - child |
984 |
885 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,974 |
1,899 |
$38K |
| D1206 |
Topical application of fluoride varnish |
858 |
764 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,998 |
1,904 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
700 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
888 |
796 |
$23K |
| D0274 |
Bitewings - four radiographic images |
769 |
749 |
$17K |
| D1110 |
Prophylaxis - adult |
903 |
869 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
383 |
104 |
$15K |
| D0160 |
|
553 |
542 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,132 |
1,067 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
27 |
$5K |
| D5214 |
|
23 |
20 |
$4K |
| D5213 |
|
15 |
13 |
$4K |
| D0190 |
|
91 |
90 |
$1K |