| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
4,548 |
4,266 |
$70K |
| D1110 |
Prophylaxis - adult |
1,298 |
1,245 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,530 |
1,472 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,851 |
3,423 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,006 |
1,920 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,353 |
1,290 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,392 |
1,330 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
79 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
38 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
329 |
$10K |
| D1120 |
Prophylaxis - child |
333 |
332 |
$10K |
| D2394 |
|
35 |
25 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
50 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$3K |