| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,445 |
2,344 |
$66K |
| D1120 |
Prophylaxis - child |
1,624 |
1,556 |
$65K |
| D9110 |
|
496 |
435 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
758 |
733 |
$20K |
| D1206 |
Topical application of fluoride varnish |
651 |
630 |
$16K |
| D2332 |
|
103 |
52 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
147 |
$14K |
| D1110 |
Prophylaxis - adult |
295 |
255 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,316 |
1,215 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
79 |
$7K |
| D0274 |
Bitewings - four radiographic images |
438 |
404 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
289 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
96 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
966 |
858 |
$4K |
| D0272 |
Bitewings - two radiographic images |
293 |
279 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
32 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
83 |
$1K |
| D0330 |
Panoramic radiographic image |
53 |
39 |
$813.60 |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
43 |
$346.44 |
| D0270 |
|
42 |
40 |
$224.00 |