| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
652 |
642 |
$36K |
| D0330 |
Panoramic radiographic image |
975 |
923 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,117 |
1,099 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
700 |
311 |
$28K |
| D8660 |
|
613 |
574 |
$23K |
| D1120 |
Prophylaxis - child |
507 |
494 |
$22K |
| D1206 |
Topical application of fluoride varnish |
623 |
610 |
$22K |
| D0274 |
Bitewings - four radiographic images |
773 |
758 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,132 |
1,109 |
$13K |
| D1110 |
Prophylaxis - adult |
361 |
355 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,621 |
1,016 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
561 |
554 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
238 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
42 |
$5K |
| D7220 |
|
48 |
30 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
48 |
$3K |
| D1351 |
Sealant - per tooth |
97 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$1K |