| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
4,082 |
3,934 |
$269K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,563 |
1,487 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,493 |
1,693 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,391 |
5,183 |
$152K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,859 |
1,142 |
$144K |
| D1110 |
Prophylaxis - adult |
3,453 |
3,383 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,617 |
3,489 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,997 |
2,951 |
$60K |
| D2394 |
|
572 |
431 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
728 |
469 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,958 |
3,628 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,201 |
3,991 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,166 |
1,138 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
802 |
730 |
$18K |
| D2335 |
|
165 |
105 |
$17K |
| D2950 |
|
111 |
89 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
17 |
12 |
$14K |
| D1120 |
Prophylaxis - child |
628 |
614 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
179 |
95 |
$10K |
| D0330 |
Panoramic radiographic image |
245 |
232 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
62 |
$6K |
| D2160 |
|
67 |
43 |
$4K |
| D0272 |
Bitewings - two radiographic images |
305 |
300 |
$3K |
| D1320 |
|
207 |
205 |
$3K |
| D2332 |
|
27 |
14 |
$2K |
| D2140 |
|
22 |
14 |
$880.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$180.00 |
| D1203 |
|
21 |
21 |
$0.00 |