| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,265 |
1,160 |
$40K |
| D1351 |
Sealant - per tooth |
1,753 |
309 |
$32K |
| D1120 |
Prophylaxis - child |
1,304 |
1,221 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
249 |
146 |
$22K |
| D0330 |
Panoramic radiographic image |
538 |
496 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,074 |
1,011 |
$20K |
| D0274 |
Bitewings - four radiographic images |
482 |
425 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
235 |
214 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
82 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
570 |
470 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
39 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
142 |
142 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
91 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
72 |
$1K |
| D1999 |
|
39 |
27 |
$0.00 |