| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,359 |
2,878 |
$117K |
| D1110 |
Prophylaxis - adult |
3,081 |
2,812 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,044 |
1,809 |
$104K |
| D1206 |
Topical application of fluoride varnish |
4,471 |
4,113 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
950 |
513 |
$61K |
| D1120 |
Prophylaxis - child |
1,469 |
1,381 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,211 |
1,887 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,701 |
1,555 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,051 |
393 |
$51K |
| D0330 |
Panoramic radiographic image |
684 |
580 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,333 |
1,265 |
$34K |
| D7250 |
|
324 |
105 |
$34K |
| D1351 |
Sealant - per tooth |
1,003 |
185 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
376 |
180 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,083 |
1,880 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,127 |
1,237 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
259 |
92 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
15 |
$11K |
| D2950 |
|
187 |
110 |
$9K |
| D2330 |
|
129 |
67 |
$8K |
| D2940 |
|
146 |
81 |
$4K |
| D0272 |
Bitewings - two radiographic images |
76 |
72 |
$2K |
| D1320 |
|
35 |
32 |
$111.05 |