| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,327 |
1,190 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
318 |
$34K |
| D1120 |
Prophylaxis - child |
1,823 |
1,459 |
$27K |
| D0330 |
Panoramic radiographic image |
691 |
600 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
247 |
131 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
862 |
677 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
152 |
71 |
$15K |
| D1351 |
Sealant - per tooth |
636 |
143 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,051 |
843 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
110 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
962 |
831 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
291 |
250 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
39 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
612 |
424 |
$3K |
| D0274 |
Bitewings - four radiographic images |
122 |
118 |
$3K |
| D0272 |
Bitewings - two radiographic images |
218 |
190 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$170.71 |