| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,862 |
4,532 |
$135K |
| D1110 |
Prophylaxis - adult |
1,566 |
1,542 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
833 |
510 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,154 |
2,115 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
906 |
871 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,475 |
3,338 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
955 |
945 |
$26K |
| D1999 |
|
1,355 |
1,075 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
339 |
331 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
163 |
$16K |
| D5110 |
|
42 |
40 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,892 |
1,979 |
$8K |
| D0274 |
Bitewings - four radiographic images |
572 |
567 |
$7K |
| D5120 |
|
14 |
14 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
24 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| D4341 |
|
28 |
13 |
$1K |