| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,225 |
3,132 |
$79K |
| D1110 |
Prophylaxis - adult |
1,962 |
1,880 |
$68K |
| D1120 |
Prophylaxis - child |
1,891 |
1,838 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,287 |
3,185 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,098 |
1,049 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,098 |
1,990 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,255 |
1,646 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
239 |
182 |
$25K |
| D0330 |
Panoramic radiographic image |
338 |
320 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
327 |
$14K |
| D0272 |
Bitewings - two radiographic images |
559 |
542 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
86 |
$9K |
| D1351 |
Sealant - per tooth |
291 |
93 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
78 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
28 |
$3K |