| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,667 |
3,814 |
$108K |
| D1110 |
Prophylaxis - adult |
3,583 |
3,141 |
$106K |
| D2394 |
|
911 |
407 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,171 |
485 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,376 |
2,945 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,416 |
3,080 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,260 |
3,441 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,524 |
3,171 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,062 |
5,170 |
$58K |
| D1120 |
Prophylaxis - child |
1,060 |
984 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,324 |
1,162 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
849 |
776 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
917 |
239 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
441 |
223 |
$27K |
| D0330 |
Panoramic radiographic image |
1,080 |
532 |
$24K |
| D1206 |
Topical application of fluoride varnish |
939 |
785 |
$14K |
| D2335 |
|
30 |
14 |
$3K |
| D2332 |
|
19 |
12 |
$2K |
| D0270 |
|
143 |
113 |
$623.56 |