| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,609 |
5,295 |
$135K |
| D1110 |
Prophylaxis - adult |
3,291 |
3,073 |
$113K |
| D0330 |
Panoramic radiographic image |
1,096 |
993 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,737 |
1,575 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,237 |
1,086 |
$42K |
| D1120 |
Prophylaxis - child |
1,269 |
1,195 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
573 |
547 |
$19K |
| D1206 |
Topical application of fluoride varnish |
826 |
779 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
669 |
613 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
511 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
57 |
$8K |
| 99199 |
Unlisted special service, procedure or report |
868 |
659 |
$6K |
| D0272 |
Bitewings - two radiographic images |
203 |
197 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
24 |
$314.50 |