| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
780 |
662 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
378 |
326 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
571 |
77 |
$17K |
| D1120 |
Prophylaxis - child |
297 |
253 |
$11K |
| D1206 |
Topical application of fluoride varnish |
297 |
253 |
$8K |
| D1351 |
Sealant - per tooth |
542 |
79 |
$8K |
| D0274 |
Bitewings - four radiographic images |
371 |
329 |
$7K |
| D0350 |
|
421 |
356 |
$7K |
| D0330 |
Panoramic radiographic image |
200 |
165 |
$6K |
| D1110 |
Prophylaxis - adult |
312 |
282 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
561 |
487 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
134 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
509 |
441 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
17 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
12 |
$2K |
| D2160 |
|
27 |
13 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
67 |
57 |
$880.00 |
| D4355 |
|
37 |
26 |
$735.00 |
| D0601 |
|
150 |
133 |
$615.00 |
| D9215 |
|
75 |
43 |
$12.30 |
| D9310 |
|
80 |
58 |
$0.00 |