| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,667 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
382 |
$50K |
| D1120 |
Prophylaxis - child |
1,093 |
1,091 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,908 |
1,900 |
$36K |
| D1110 |
Prophylaxis - adult |
798 |
792 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
303 |
162 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,037 |
1,034 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
485 |
266 |
$28K |
| D9410 |
|
270 |
269 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,947 |
1,929 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
332 |
329 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,695 |
1,637 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
436 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
433 |
433 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
148 |
65 |
$10K |
| D0272 |
Bitewings - two radiographic images |
405 |
404 |
$9K |
| D2332 |
|
32 |
15 |
$4K |
| D0330 |
Panoramic radiographic image |
137 |
137 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |