| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,723 |
$52K |
| D1120 |
Prophylaxis - child |
1,760 |
1,723 |
$49K |
| D1110 |
Prophylaxis - adult |
1,255 |
1,231 |
$46K |
| D7240 |
Removal of impacted tooth - completely bony |
232 |
46 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,736 |
1,707 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
190 |
$19K |
| D0330 |
Panoramic radiographic image |
347 |
341 |
$16K |
| D0272 |
Bitewings - two radiographic images |
856 |
840 |
$15K |
| D2140 |
|
234 |
180 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
68 |
$6K |
| D9222 |
|
55 |
48 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
81 |
49 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
30 |
$4K |
| D0274 |
Bitewings - four radiographic images |
119 |
117 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
93 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$281.60 |
| D9610 |
|
66 |
49 |
$0.00 |