| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
649 |
613 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
559 |
$23K |
| D1351 |
Sealant - per tooth |
81 |
52 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
69 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
36 |
$4K |
| D0274 |
Bitewings - four radiographic images |
181 |
178 |
$3K |
| D0330 |
Panoramic radiographic image |
93 |
92 |
$2K |
| D1120 |
Prophylaxis - child |
489 |
486 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
57 |
$1K |
| D9110 |
|
20 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
435 |
433 |
$876.10 |
| D0272 |
Bitewings - two radiographic images |
63 |
62 |
$785.50 |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
15 |
$631.62 |
| D0270 |
|
13 |
13 |
$220.80 |
| D2140 |
|
12 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
25 |
$0.00 |