| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,084 |
6,965 |
$169K |
| D1110 |
Prophylaxis - adult |
3,710 |
3,647 |
$155K |
| D1120 |
Prophylaxis - child |
4,231 |
4,168 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,542 |
4,510 |
$93K |
| D0330 |
Panoramic radiographic image |
1,508 |
1,478 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,792 |
2,720 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,603 |
1,581 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
488 |
118 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
306 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
520 |
508 |
$15K |
| D0272 |
Bitewings - two radiographic images |
497 |
493 |
$9K |
| D1351 |
Sealant - per tooth |
59 |
13 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D2330 |
|
20 |
12 |
$999.30 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
38 |
$878.89 |