| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,028 |
1,028 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,681 |
1,678 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
886 |
324 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
962 |
684 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,402 |
1,378 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
344 |
282 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
404 |
135 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,429 |
2,373 |
$6K |
| D1110 |
Prophylaxis - adult |
513 |
513 |
$6K |
| D0330 |
Panoramic radiographic image |
1,426 |
1,420 |
$4K |
| D0603 |
|
963 |
962 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,503 |
1,500 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
220 |
$4K |
| D2394 |
|
105 |
89 |
$4K |
| D1206 |
Topical application of fluoride varnish |
646 |
643 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
336 |
333 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,807 |
1,252 |
$2K |
| D0270 |
|
415 |
411 |
$1K |
| D0602 |
|
262 |
261 |
$1K |
| D1320 |
|
174 |
174 |
$650.00 |
| D9310 |
|
28 |
28 |
$495.00 |
| D4910 |
|
29 |
29 |
$350.00 |
| D4342 |
|
23 |
13 |
$276.00 |
| D1354 |
|
232 |
58 |
$266.00 |
| D1120 |
Prophylaxis - child |
31 |
31 |
$160.00 |
| D0601 |
|
27 |
26 |
$77.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$60.00 |
| D1310 |
|
973 |
970 |
$10.00 |
| D1330 |
|
1,117 |
1,108 |
$0.00 |
| D9995 |
|
14 |
14 |
$0.00 |
| D4921 |
|
60 |
25 |
$0.00 |