| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,918 |
2,895 |
$73K |
| D1110 |
Prophylaxis - adult |
1,537 |
1,523 |
$69K |
| D1120 |
Prophylaxis - child |
1,587 |
1,570 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
461 |
340 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,886 |
1,871 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,989 |
1,915 |
$25K |
| D0272 |
Bitewings - two radiographic images |
762 |
755 |
$17K |
| D0274 |
Bitewings - four radiographic images |
531 |
528 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
102 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,310 |
1,183 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
264 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
69 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
91 |
$3K |