| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,799 |
1,730 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,734 |
3,611 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,285 |
1,069 |
$84K |
| D1110 |
Prophylaxis - adult |
1,233 |
1,184 |
$54K |
| D1120 |
Prophylaxis - child |
575 |
559 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,563 |
1,529 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
622 |
583 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
252 |
$18K |
| D2140 |
|
428 |
313 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
110 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
972 |
933 |
$9K |
| D1351 |
Sealant - per tooth |
382 |
82 |
$9K |
| D0274 |
Bitewings - four radiographic images |
235 |
223 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
241 |
$2K |
| D2331 |
|
44 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
34 |
$2K |
| D2330 |
|
39 |
26 |
$2K |
| D9110 |
|
33 |
26 |
$528.78 |