| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,025 |
2,024 |
$73K |
| D1120 |
Prophylaxis - child |
1,963 |
1,963 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,854 |
1,852 |
$26K |
| D0272 |
Bitewings - two radiographic images |
919 |
919 |
$23K |
| D0274 |
Bitewings - four radiographic images |
497 |
497 |
$21K |
| D1110 |
Prophylaxis - adult |
254 |
254 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
440 |
$7K |
| D1206 |
Topical application of fluoride varnish |
462 |
462 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
53 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
68 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
64 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$975.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$930.68 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$880.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
15 |
$215.10 |