| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,345 |
2,336 |
$237K |
| D1110 |
Prophylaxis - adult |
4,718 |
4,690 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
3,870 |
3,837 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,295 |
663 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
668 |
324 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,713 |
2,705 |
$28K |
| D1351 |
Sealant - per tooth |
9,405 |
2,090 |
$23K |
| D1120 |
Prophylaxis - child |
1,729 |
1,720 |
$15K |
| D1330 |
|
6,532 |
6,495 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,320 |
6,284 |
$8K |
| D0274 |
Bitewings - four radiographic images |
2,144 |
2,129 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,515 |
3,453 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
235 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,022 |
2,965 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
12 |
$955.00 |
| D0272 |
Bitewings - two radiographic images |
542 |
538 |
$690.10 |