| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,372 |
1,321 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
805 |
510 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
875 |
486 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,096 |
2,061 |
$51K |
| D1110 |
Prophylaxis - adult |
1,260 |
1,243 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,045 |
1,009 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,179 |
2,121 |
$18K |
| D1120 |
Prophylaxis - child |
583 |
580 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,269 |
1,250 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
131 |
56 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,976 |
1,262 |
$16K |
| D0274 |
Bitewings - four radiographic images |
799 |
795 |
$16K |
| D1206 |
Topical application of fluoride varnish |
876 |
866 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
72 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
56 |
$9K |
| D3310 |
|
15 |
12 |
$6K |
| D2950 |
|
166 |
129 |
$6K |
| D4342 |
|
151 |
56 |
$4K |
| D4341 |
|
64 |
27 |
$4K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
45 |
$997.92 |
| D0270 |
|
20 |
13 |
$188.89 |
| D4910 |
|
73 |
73 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
42 |
39 |
$0.00 |
| D3320 |
|
13 |
12 |
$0.00 |