| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,567 |
1,433 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,050 |
1,852 |
$61K |
| D1120 |
Prophylaxis - child |
1,120 |
1,043 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,590 |
1,437 |
$41K |
| D1351 |
Sealant - per tooth |
1,986 |
348 |
$40K |
| D0330 |
Panoramic radiographic image |
1,085 |
962 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,161 |
1,085 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,181 |
1,056 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,755 |
1,605 |
$20K |
| D1110 |
Prophylaxis - adult |
712 |
639 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
953 |
858 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
341 |
142 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,426 |
1,652 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
572 |
515 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
38 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
38 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
47 |
47 |
$1K |
| D0350 |
|
40 |
33 |
$697.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
30 |
30 |
$600.00 |
| D0270 |
|
27 |
24 |
$271.17 |
| D1999 |
|
20 |
17 |
$0.00 |