| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,501 |
4,340 |
$178K |
| D0330 |
Panoramic radiographic image |
3,327 |
3,306 |
$174K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,408 |
953 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,680 |
692 |
$124K |
| D1110 |
Prophylaxis - adult |
1,951 |
1,934 |
$100K |
| D1120 |
Prophylaxis - child |
1,378 |
1,366 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,173 |
2,150 |
$67K |
| D5110 |
|
87 |
87 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
806 |
640 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,032 |
760 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,233 |
1,223 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,358 |
1,347 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,984 |
1,952 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,636 |
2,591 |
$23K |
| D5120 |
|
38 |
38 |
$23K |
| D0272 |
Bitewings - two radiographic images |
462 |
460 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
78 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
969 |
671 |
$6K |
| D2331 |
|
75 |
53 |
$5K |
| D2330 |
|
75 |
48 |
$4K |
| D2335 |
|
45 |
27 |
$4K |
| D2332 |
|
46 |
30 |
$3K |
| D7250 |
|
42 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
120 |
$2K |