| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,936 |
1,871 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,293 |
488 |
$60K |
| D0160 |
|
1,631 |
1,409 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,478 |
1,426 |
$32K |
| D1120 |
Prophylaxis - child |
809 |
754 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,056 |
939 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,162 |
2,047 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
591 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
249 |
102 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,966 |
1,696 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
302 |
254 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
57 |
$4K |
| D1351 |
Sealant - per tooth |
266 |
33 |
$4K |
| D0330 |
Panoramic radiographic image |
108 |
106 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
342 |
340 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
60 |
60 |
$2K |
| D1206 |
Topical application of fluoride varnish |
47 |
47 |
$1K |
| D1110 |
Prophylaxis - adult |
69 |
63 |
$1K |