| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,239 |
1,185 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
622 |
$35K |
| D1120 |
Prophylaxis - child |
650 |
635 |
$35K |
| D0330 |
Panoramic radiographic image |
1,044 |
1,029 |
$34K |
| D1351 |
Sealant - per tooth |
1,453 |
194 |
$31K |
| D1206 |
Topical application of fluoride varnish |
639 |
625 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
431 |
110 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
975 |
942 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
670 |
655 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
304 |
$9K |
| D0274 |
Bitewings - four radiographic images |
390 |
385 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,438 |
581 |
$8K |
| D9248 |
|
74 |
71 |
$6K |
| D1110 |
Prophylaxis - adult |
213 |
207 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
38 |
$3K |
| D0270 |
|
195 |
190 |
$2K |
| D4355 |
|
31 |
29 |
$2K |
| D0601 |
|
144 |
143 |
$690.00 |
| D0602 |
|
105 |
104 |
$405.00 |
| D0603 |
|
38 |
34 |
$65.00 |