| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,641 |
6,151 |
$228K |
| D1351 |
Sealant - per tooth |
7,963 |
1,242 |
$180K |
| D1120 |
Prophylaxis - child |
6,379 |
5,946 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,237 |
619 |
$119K |
| D0330 |
Panoramic radiographic image |
2,995 |
2,776 |
$96K |
| D1206 |
Topical application of fluoride varnish |
4,596 |
4,399 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,947 |
2,714 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
630 |
630 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,735 |
2,511 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
427 |
280 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
935 |
860 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,928 |
1,626 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
166 |
104 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
138 |
$19K |
| D1110 |
Prophylaxis - adult |
418 |
340 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,091 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
835 |
310 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
39 |
$934.42 |