| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,688 |
8,123 |
$199K |
| D1120 |
Prophylaxis - child |
6,311 |
5,879 |
$197K |
| D1206 |
Topical application of fluoride varnish |
9,980 |
9,333 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,550 |
1,771 |
$176K |
| D1110 |
Prophylaxis - adult |
3,862 |
3,618 |
$156K |
| D0330 |
Panoramic radiographic image |
2,751 |
2,567 |
$119K |
| D0274 |
Bitewings - four radiographic images |
2,491 |
2,331 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,565 |
2,405 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
490 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,222 |
1,138 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
448 |
226 |
$27K |
| D9110 |
|
535 |
485 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
265 |
184 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,150 |
1,045 |
$13K |
| D1351 |
Sealant - per tooth |
56 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$608.85 |
| D1999 |
|
42 |
38 |
$0.00 |