| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,463 |
2,315 |
$148K |
| D1110 |
Prophylaxis - adult |
3,021 |
2,838 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,851 |
1,043 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,448 |
3,268 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,060 |
707 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,221 |
487 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,484 |
2,327 |
$57K |
| D2394 |
|
526 |
274 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,004 |
1,885 |
$54K |
| D1120 |
Prophylaxis - child |
1,106 |
1,037 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,404 |
1,319 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
385 |
248 |
$21K |
| D0330 |
Panoramic radiographic image |
354 |
337 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
804 |
727 |
$20K |
| D1206 |
Topical application of fluoride varnish |
513 |
494 |
$15K |
| D2335 |
|
54 |
25 |
$10K |
| D1320 |
|
511 |
477 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
820 |
744 |
$6K |
| D3320 |
|
14 |
12 |
$4K |
| D2331 |
|
31 |
21 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
79 |
$1K |
| D0272 |
Bitewings - two radiographic images |
52 |
49 |
$982.50 |