| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,091 |
1,056 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
672 |
593 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
285 |
$15K |
| D0999 |
Unspecified diagnostic procedure, by report |
109 |
83 |
$8K |
| D9110 |
|
53 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
190 |
$4K |
| D1206 |
Topical application of fluoride varnish |
953 |
935 |
$4K |
| D1351 |
Sealant - per tooth |
146 |
114 |
$2K |
| D0602 |
|
46 |
38 |
$2K |
| D0274 |
Bitewings - four radiographic images |
186 |
184 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
200 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
146 |
$1K |
| D1120 |
Prophylaxis - child |
956 |
942 |
$1K |
| D0272 |
Bitewings - two radiographic images |
158 |
157 |
$441.60 |
| D0330 |
Panoramic radiographic image |
112 |
111 |
$343.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
115 |
$260.94 |
| D0603 |
|
82 |
81 |
$0.00 |
| D0601 |
|
91 |
91 |
$0.00 |