| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,308 |
1,302 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,170 |
626 |
$78K |
| D1110 |
Prophylaxis - adult |
748 |
746 |
$62K |
| D1120 |
Prophylaxis - child |
1,438 |
1,432 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
790 |
789 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,083 |
1,913 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
294 |
$28K |
| D9430 |
|
838 |
805 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,224 |
1,220 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
420 |
420 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,157 |
1,155 |
$19K |
| D1351 |
Sealant - per tooth |
700 |
156 |
$17K |
| D0330 |
Panoramic radiographic image |
567 |
555 |
$17K |
| D4910 |
|
163 |
162 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,056 |
1,051 |
$12K |
| D0350 |
|
539 |
443 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
66 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
74 |
$8K |
| D4341 |
|
100 |
25 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
612 |
541 |
$7K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$1K |