| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,668 |
14,528 |
$508K |
| D1110 |
Prophylaxis - adult |
8,356 |
8,284 |
$384K |
| D0274 |
Bitewings - four radiographic images |
11,869 |
11,760 |
$350K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,533 |
3,111 |
$330K |
| D1120 |
Prophylaxis - child |
9,515 |
9,444 |
$302K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,001 |
13,897 |
$252K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,835 |
1,796 |
$247K |
| D0210 |
Intraoral - complete series of radiographic images |
3,777 |
3,743 |
$224K |
| D5213 |
|
278 |
266 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
17,017 |
16,650 |
$193K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,578 |
840 |
$169K |
| D1351 |
Sealant - per tooth |
6,926 |
1,285 |
$163K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,674 |
1,411 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
4,801 |
4,606 |
$140K |
| D0330 |
Panoramic radiographic image |
2,657 |
2,590 |
$137K |
| D5214 |
|
174 |
166 |
$136K |
| D4341 |
|
1,166 |
517 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,346 |
1,613 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,901 |
12,782 |
$117K |
| D2335 |
|
676 |
452 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,727 |
3,714 |
$85K |
| D2331 |
|
939 |
681 |
$81K |
| D1206 |
Topical application of fluoride varnish |
4,078 |
4,037 |
$76K |
| D2332 |
|
240 |
179 |
$26K |
| D2330 |
|
370 |
232 |
$25K |
| D7250 |
|
200 |
84 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
121 |
43 |
$23K |
| D5110 |
|
24 |
24 |
$18K |
| D0272 |
Bitewings - two radiographic images |
721 |
719 |
$15K |
| D9239 |
|
82 |
81 |
$9K |
| D9243 |
|
145 |
81 |
$8K |
| D2940 |
|
177 |
162 |
$8K |
| D2394 |
|
38 |
37 |
$4K |
| D9610 |
|
81 |
81 |
$2K |