| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,912 |
2,804 |
$88K |
| D1120 |
Prophylaxis - child |
2,268 |
2,181 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,330 |
1,186 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,066 |
2,941 |
$54K |
| D1110 |
Prophylaxis - adult |
1,025 |
989 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,190 |
1,139 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
130 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
62 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
178 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
869 |
806 |
$7K |
| D1351 |
Sealant - per tooth |
228 |
64 |
$7K |
| D1330 |
|
227 |
198 |
$3K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$801.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
53 |
$431.88 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$312.00 |