| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,895 |
1,839 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,436 |
750 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,325 |
623 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,443 |
2,408 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
614 |
410 |
$58K |
| D1110 |
Prophylaxis - adult |
1,322 |
1,312 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
424 |
194 |
$38K |
| D2394 |
|
259 |
211 |
$37K |
| D0274 |
Bitewings - four radiographic images |
863 |
853 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
804 |
793 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
439 |
418 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,981 |
1,013 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
704 |
697 |
$13K |
| D2335 |
|
65 |
40 |
$12K |
| D1120 |
Prophylaxis - child |
372 |
366 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,302 |
1,259 |
$9K |
| D0330 |
Panoramic radiographic image |
205 |
202 |
$9K |
| D4342 |
|
96 |
23 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
31 |
$3K |
| D1351 |
Sealant - per tooth |
110 |
28 |
$2K |
| D0350 |
|
57 |
56 |
$677.05 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$190.00 |