| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,025 |
5,656 |
$189K |
| D1120 |
Prophylaxis - child |
3,044 |
2,926 |
$165K |
| D1206 |
Topical application of fluoride varnish |
3,159 |
3,025 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
1,779 |
1,690 |
$97K |
| D1351 |
Sealant - per tooth |
4,197 |
837 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,790 |
3,668 |
$85K |
| D2740 |
Crown - porcelain/ceramic |
192 |
102 |
$81K |
| D0330 |
Panoramic radiographic image |
2,173 |
2,075 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
4,567 |
4,394 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,564 |
5,597 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,549 |
2,452 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
849 |
364 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
909 |
440 |
$47K |
| D2950 |
|
264 |
137 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
760 |
725 |
$23K |
| D5214 |
|
15 |
15 |
$9K |
| D1110 |
Prophylaxis - adult |
215 |
211 |
$4K |
| D0603 |
|
1,055 |
1,024 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
110 |
110 |
$3K |
| D7311 |
|
30 |
22 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
113 |
113 |
$2K |
| D0601 |
|
716 |
693 |
$2K |
| D0270 |
|
188 |
180 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
14 |
$2K |
| D9310 |
|
14 |
14 |
$861.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
19 |
$861.00 |
| D0350 |
|
33 |
31 |
$307.50 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$254.52 |
| D0602 |
|
12 |
12 |
$40.00 |