| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,500 |
2,425 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,104 |
377 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
1,245 |
1,223 |
$37K |
| D0330 |
Panoramic radiographic image |
566 |
535 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,777 |
1,688 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
112 |
$29K |
| D1110 |
Prophylaxis - adult |
444 |
435 |
$23K |
| D0274 |
Bitewings - four radiographic images |
764 |
749 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,009 |
994 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,228 |
1,207 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,056 |
958 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
183 |
$6K |
| D0240 |
|
443 |
164 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
100 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
17 |
$2K |
| D9248 |
|
29 |
28 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
62 |
$867.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
53 |
$751.78 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$498.48 |