| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,713 |
1,355 |
$55K |
| D1110 |
Prophylaxis - adult |
1,558 |
1,287 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,080 |
895 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
482 |
200 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,421 |
1,215 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
654 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,360 |
1,100 |
$18K |
| D1120 |
Prophylaxis - child |
567 |
463 |
$13K |
| D0330 |
Panoramic radiographic image |
816 |
626 |
$10K |
| D1351 |
Sealant - per tooth |
244 |
53 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
272 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
51 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D0250 |
|
27 |
27 |
$368.78 |
| D0274 |
Bitewings - four radiographic images |
20 |
13 |
$335.50 |