| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,693 |
1,622 |
$78K |
| D1110 |
Prophylaxis - adult |
741 |
705 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
250 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
213 |
$19K |
| D0330 |
Panoramic radiographic image |
185 |
177 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
173 |
$11K |
| D1351 |
Sealant - per tooth |
780 |
278 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
54 |
$5K |
| D1330 |
|
1,933 |
1,852 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
131 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,569 |
1,483 |
$1K |
| D7111 |
|
17 |
13 |
$772.26 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,891 |
1,814 |
$653.03 |
| D1120 |
Prophylaxis - child |
1,151 |
1,111 |
$537.93 |
| D3120 |
|
85 |
71 |
$108.37 |
| D0274 |
Bitewings - four radiographic images |
745 |
706 |
$16.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,442 |
1,362 |
$10.00 |
| D0272 |
Bitewings - two radiographic images |
947 |
914 |
$0.00 |
| D0240 |
|
325 |
313 |
$0.00 |