| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,392 |
6,613 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,328 |
4,652 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,723 |
798 |
$164K |
| D1110 |
Prophylaxis - adult |
4,430 |
4,090 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
11,843 |
10,417 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,641 |
5,878 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
4,695 |
4,386 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,804 |
763 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
2,062 |
1,717 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,132 |
414 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,174 |
2,921 |
$84K |
| D0330 |
Panoramic radiographic image |
2,151 |
1,942 |
$78K |
| D1206 |
Topical application of fluoride varnish |
4,253 |
3,898 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
340 |
173 |
$38K |
| D1120 |
Prophylaxis - child |
1,066 |
1,005 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
157 |
107 |
$9K |
| D0270 |
|
891 |
773 |
$6K |
| D4355 |
|
75 |
71 |
$5K |
| D1351 |
Sealant - per tooth |
90 |
17 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
139 |
129 |
$2K |