| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,222 |
3,242 |
$143K |
| D0274 |
Bitewings - four radiographic images |
4,019 |
3,851 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,645 |
5,390 |
$114K |
| D1110 |
Prophylaxis - adult |
3,368 |
3,175 |
$114K |
| D1120 |
Prophylaxis - child |
2,268 |
2,212 |
$98K |
| D0330 |
Panoramic radiographic image |
1,747 |
1,551 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
867 |
505 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,214 |
2,032 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,292 |
2,210 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,351 |
3,146 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
647 |
333 |
$36K |
| D1351 |
Sealant - per tooth |
702 |
154 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
468 |
450 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,988 |
1,206 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
52 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
145 |
96 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
49 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
38 |
$5K |
| D2140 |
|
87 |
61 |
$5K |
| D7250 |
|
37 |
17 |
$4K |
| D2160 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$689.92 |