| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,742 |
4,286 |
$33K |
| D1110 |
Prophylaxis - adult |
2,502 |
2,437 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
395 |
$14K |
| D1120 |
Prophylaxis - child |
2,552 |
2,542 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
4,967 |
4,861 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
868 |
777 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,511 |
3,482 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
859 |
787 |
$6K |
| D9990 |
|
473 |
462 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,152 |
1,145 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,377 |
2,377 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
126 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,121 |
1,117 |
$2K |
| D0270 |
|
408 |
396 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
125 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
98 |
$1K |
| D1206 |
Topical application of fluoride varnish |
248 |
248 |
$967.16 |
| D9110 |
|
76 |
69 |
$906.10 |
| D9310 |
|
39 |
39 |
$688.75 |
| D1354 |
|
37 |
13 |
$582.15 |
| D0330 |
Panoramic radiographic image |
18 |
15 |
$191.01 |
| D0240 |
|
168 |
168 |
$53.94 |