| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,059 |
1,955 |
$97K |
| D1110 |
Prophylaxis - adult |
2,733 |
2,650 |
$87K |
| D1351 |
Sealant - per tooth |
3,244 |
502 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,368 |
2,268 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
783 |
424 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,445 |
2,332 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,533 |
2,466 |
$40K |
| D1120 |
Prophylaxis - child |
1,326 |
1,297 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,387 |
1,357 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,413 |
1,347 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
236 |
97 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,496 |
1,362 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
152 |
106 |
$11K |
| D0330 |
Panoramic radiographic image |
216 |
202 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
91 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$78.10 |