| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,574 |
2,527 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
858 |
600 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,786 |
1,750 |
$60K |
| D1120 |
Prophylaxis - child |
1,922 |
1,891 |
$60K |
| D1110 |
Prophylaxis - adult |
1,422 |
1,391 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,471 |
3,350 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,917 |
1,897 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,545 |
1,511 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
940 |
918 |
$27K |
| D0330 |
Panoramic radiographic image |
942 |
912 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,718 |
2,628 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,182 |
1,144 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
178 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
92 |
$10K |
| D0272 |
Bitewings - two radiographic images |
393 |
385 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
42 |
$4K |
| D2331 |
|
43 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$2K |