| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,485 |
2,354 |
$126K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,141 |
381 |
$52K |
| D0160 |
|
1,608 |
1,433 |
$36K |
| D1120 |
Prophylaxis - child |
577 |
487 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
613 |
$17K |
| D1351 |
Sealant - per tooth |
1,154 |
123 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
685 |
651 |
$8K |
| D0274 |
Bitewings - four radiographic images |
246 |
238 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
124 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
488 |
390 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
101 |
94 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
321 |
261 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
54 |
32 |
$1K |
| D1110 |
Prophylaxis - adult |
34 |
27 |
$505.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
15 |
15 |
$450.00 |