| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,684 |
2,547 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,598 |
855 |
$115K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,094 |
471 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,784 |
2,654 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,088 |
589 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,614 |
1,531 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,370 |
2,256 |
$35K |
| D1120 |
Prophylaxis - child |
1,152 |
1,101 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,822 |
1,717 |
$33K |
| D1110 |
Prophylaxis - adult |
858 |
815 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
944 |
$24K |
| D4355 |
|
319 |
296 |
$22K |
| D4346 |
|
160 |
154 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
83 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
774 |
$8K |
| D0330 |
Panoramic radiographic image |
139 |
135 |
$6K |
| D1206 |
Topical application of fluoride varnish |
398 |
339 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
190 |
180 |
$1K |
| D0270 |
|
58 |
55 |
$467.71 |
| D0170 |
|
27 |
26 |
$449.10 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$445.40 |