| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
1,107 |
$31K |
| D1110 |
Prophylaxis - adult |
619 |
616 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
400 |
312 |
$29K |
| D1120 |
Prophylaxis - child |
669 |
668 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
151 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
707 |
701 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
507 |
506 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
184 |
$13K |
| D0274 |
Bitewings - four radiographic images |
592 |
590 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,528 |
1,495 |
$10K |
| D0330 |
Panoramic radiographic image |
347 |
343 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,249 |
1,220 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
303 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
289 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
53 |
$4K |
| D9110 |
|
53 |
52 |
$3K |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$928.20 |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$221.80 |
| D0270 |
|
38 |
38 |
$212.80 |