| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,555 |
13,275 |
$475K |
| D0274 |
Bitewings - four radiographic images |
12,583 |
12,287 |
$371K |
| D1110 |
Prophylaxis - adult |
7,804 |
7,638 |
$357K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,814 |
2,750 |
$281K |
| D1120 |
Prophylaxis - child |
8,391 |
8,227 |
$271K |
| D0220 |
Intraoral - periapical first radiographic image |
16,415 |
15,910 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,120 |
9,955 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,931 |
2,035 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,554 |
2,535 |
$156K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,163 |
1,110 |
$141K |
| D1206 |
Topical application of fluoride varnish |
6,841 |
6,667 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,436 |
13,125 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,320 |
1,140 |
$117K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
867 |
414 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
3,072 |
2,956 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,686 |
3,617 |
$84K |
| D2331 |
|
940 |
668 |
$82K |
| D0330 |
Panoramic radiographic image |
1,480 |
1,423 |
$74K |
| D5213 |
|
66 |
64 |
$51K |
| D5214 |
|
40 |
38 |
$31K |
| D4346 |
|
221 |
211 |
$26K |
| D1351 |
Sealant - per tooth |
982 |
193 |
$24K |
| D2332 |
|
174 |
131 |
$18K |
| D2335 |
|
135 |
96 |
$16K |
| D2330 |
|
214 |
149 |
$14K |
| D4341 |
|
109 |
46 |
$12K |
| D0272 |
Bitewings - two radiographic images |
444 |
435 |
$9K |
| D2940 |
|
178 |
159 |
$8K |
| D2394 |
|
46 |
43 |
$5K |
| D7250 |
|
34 |
12 |
$5K |