| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,033 |
2,716 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
798 |
463 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
822 |
390 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,374 |
644 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,892 |
1,732 |
$45K |
| D1110 |
Prophylaxis - adult |
1,422 |
1,287 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,402 |
1,253 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,147 |
3,668 |
$34K |
| D4341 |
|
1,648 |
369 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,120 |
1,925 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
656 |
324 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
631 |
579 |
$11K |
| D1999 |
|
789 |
625 |
$10K |
| D0274 |
Bitewings - four radiographic images |
682 |
635 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,028 |
1,126 |
$3K |
| D1120 |
Prophylaxis - child |
78 |
75 |
$2K |
| D2335 |
|
18 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
33 |
31 |
$346.82 |
| D0272 |
Bitewings - two radiographic images |
33 |
30 |
$308.70 |