| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,345 |
2,312 |
$64K |
| D1120 |
Prophylaxis - child |
1,514 |
1,486 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
686 |
419 |
$44K |
| D1110 |
Prophylaxis - adult |
923 |
920 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,386 |
1,358 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,611 |
1,587 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,231 |
1,176 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
823 |
$20K |
| D1351 |
Sealant - per tooth |
275 |
107 |
$19K |
| D0330 |
Panoramic radiographic image |
763 |
753 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
204 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,346 |
2,306 |
$14K |
| D4342 |
|
102 |
58 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,008 |
1,975 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
105 |
99 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
276 |
$7K |
| D4341 |
|
36 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
69 |
$3K |
| D0272 |
Bitewings - two radiographic images |
252 |
247 |
$3K |
| D2332 |
|
17 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
53 |
$1K |