| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,646 |
1,585 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,263 |
2,154 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,507 |
679 |
$59K |
| D1120 |
Prophylaxis - child |
1,252 |
1,192 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
1,087 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
1,078 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,322 |
1,257 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,109 |
2,006 |
$23K |
| D0330 |
Panoramic radiographic image |
547 |
528 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,390 |
1,862 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
611 |
575 |
$12K |
| D1110 |
Prophylaxis - adult |
352 |
337 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
46 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
62 |
62 |
$2K |
| D1351 |
Sealant - per tooth |
92 |
14 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
53 |
53 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
14 |
$1K |
| D0270 |
|
18 |
17 |
$182.74 |