| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,924 |
$39K |
| D1110 |
Prophylaxis - adult |
1,584 |
1,549 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
1,150 |
1,149 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,398 |
1,363 |
$27K |
| D1120 |
Prophylaxis - child |
891 |
865 |
$23K |
| D1351 |
Sealant - per tooth |
1,134 |
170 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
210 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,271 |
1,236 |
$15K |
| D0330 |
Panoramic radiographic image |
1,121 |
1,078 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,442 |
1,388 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
51 |
$5K |
| D2140 |
|
151 |
86 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,265 |
1,212 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,220 |
833 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
65 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$814.00 |