| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,593 |
8,317 |
$220K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,327 |
664 |
$141K |
| D1120 |
Prophylaxis - child |
5,126 |
4,970 |
$137K |
| D1110 |
Prophylaxis - adult |
3,639 |
3,498 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,290 |
6,081 |
$94K |
| D0272 |
Bitewings - two radiographic images |
1,081 |
1,050 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
267 |
171 |
$16K |
| D0330 |
Panoramic radiographic image |
166 |
162 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
55 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
176 |
$7K |
| D1206 |
Topical application of fluoride varnish |
346 |
335 |
$5K |
| D1351 |
Sealant - per tooth |
84 |
21 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
91 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
29 |
$1K |
| D0274 |
Bitewings - four radiographic images |
19 |
17 |
$563.68 |