| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,670 |
4,136 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
3,007 |
2,870 |
$165K |
| D1110 |
Prophylaxis - adult |
4,973 |
4,768 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,680 |
7,369 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,059 |
1,332 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,271 |
926 |
$132K |
| D1120 |
Prophylaxis - child |
2,948 |
2,843 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,978 |
3,762 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,001 |
3,900 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,578 |
2,478 |
$79K |
| D7250 |
|
827 |
198 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
682 |
441 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,380 |
3,200 |
$37K |
| D1351 |
Sealant - per tooth |
863 |
203 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
587 |
221 |
$28K |
| D0330 |
Panoramic radiographic image |
107 |
69 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
318 |
218 |
$3K |
| D9310 |
|
143 |
138 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$823.08 |