| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,964 |
4,685 |
$122K |
| D1206 |
Topical application of fluoride varnish |
6,181 |
5,844 |
$94K |
| D1120 |
Prophylaxis - child |
3,403 |
3,244 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
798 |
533 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,418 |
1,335 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,738 |
3,445 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
532 |
347 |
$41K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,095 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,636 |
2,171 |
$30K |
| D0274 |
Bitewings - four radiographic images |
906 |
873 |
$25K |
| D0330 |
Panoramic radiographic image |
352 |
331 |
$15K |
| D0272 |
Bitewings - two radiographic images |
689 |
633 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
273 |
$10K |
| D1351 |
Sealant - per tooth |
263 |
70 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$742.80 |