| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
3,165 |
3,116 |
$107K |
| D1120 |
Prophylaxis - child |
3,077 |
3,042 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
784 |
580 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,274 |
3,232 |
$75K |
| D1110 |
Prophylaxis - adult |
2,080 |
2,042 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,217 |
3,189 |
$57K |
| D0272 |
Bitewings - two radiographic images |
1,257 |
1,239 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
634 |
626 |
$23K |
| D0330 |
Panoramic radiographic image |
363 |
361 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
125 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
227 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
463 |
450 |
$7K |
| D1206 |
Topical application of fluoride varnish |
282 |
276 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
231 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
14 |
$2K |
| D9920 |
|
44 |
44 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
14 |
$2K |
| D0240 |
|
34 |
25 |
$876.98 |
| D1999 |
|
459 |
419 |
$0.36 |