| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,880 |
1,827 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,359 |
2,278 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,341 |
527 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,636 |
1,568 |
$51K |
| D0330 |
Panoramic radiographic image |
1,035 |
990 |
$37K |
| D1120 |
Prophylaxis - child |
868 |
832 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,577 |
2,482 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,383 |
2,452 |
$30K |
| D1110 |
Prophylaxis - adult |
1,447 |
1,399 |
$30K |
| D1206 |
Topical application of fluoride varnish |
731 |
706 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,128 |
1,080 |
$19K |
| D0274 |
Bitewings - four radiographic images |
770 |
757 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
780 |
765 |
$12K |
| D1351 |
Sealant - per tooth |
548 |
113 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
84 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
86 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
41 |
$4K |
| D0240 |
|
159 |
149 |
$2K |
| D4355 |
|
112 |
89 |
$2K |
| D7311 |
|
120 |
65 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$133.12 |
| D7510 |
|
15 |
13 |
$0.00 |