| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,204 |
1,164 |
$47K |
| D1120 |
Prophylaxis - child |
1,225 |
1,181 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,054 |
1,022 |
$24K |
| D1351 |
Sealant - per tooth |
819 |
92 |
$21K |
| D0330 |
Panoramic radiographic image |
559 |
532 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
116 |
$13K |
| D0272 |
Bitewings - two radiographic images |
732 |
715 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
279 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
157 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
257 |
$3K |
| D0274 |
Bitewings - four radiographic images |
88 |
82 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$1K |