| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,238 |
1,191 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,341 |
2,149 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
554 |
509 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
629 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
729 |
715 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
90 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
869 |
856 |
$16K |
| D1110 |
Prophylaxis - adult |
321 |
304 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,627 |
1,196 |
$11K |
| D4341 |
|
245 |
90 |
$9K |
| D0274 |
Bitewings - four radiographic images |
342 |
324 |
$8K |
| D0270 |
|
640 |
615 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
114 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
82 |
$5K |
| D4910 |
|
55 |
50 |
$3K |
| D4342 |
|
89 |
42 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
42 |
42 |
$2K |
| D1999 |
|
167 |
111 |
$1K |