| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,124 |
2,074 |
$116K |
| D1351 |
Sealant - per tooth |
4,572 |
649 |
$104K |
| D1120 |
Prophylaxis - child |
2,244 |
2,190 |
$97K |
| D1206 |
Topical application of fluoride varnish |
2,441 |
2,385 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,147 |
2,061 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,559 |
2,477 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,674 |
1,635 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,049 |
2,916 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,283 |
1,239 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,985 |
3,099 |
$23K |
| D1110 |
Prophylaxis - adult |
360 |
346 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
55 |
$6K |
| D0160 |
|
68 |
61 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$1K |
| D1353 |
|
96 |
15 |
$1K |
| D0603 |
|
260 |
253 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$996.12 |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
27 |
$810.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$540.00 |