| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,357 |
11,157 |
$278K |
| D1110 |
Prophylaxis - adult |
7,047 |
6,846 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,409 |
1,643 |
$197K |
| D0274 |
Bitewings - four radiographic images |
5,604 |
5,511 |
$190K |
| D1120 |
Prophylaxis - child |
3,925 |
3,877 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
4,435 |
4,186 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,650 |
3,620 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
1,739 |
1,716 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,200 |
731 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,858 |
3,729 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
118 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
71 |
$9K |
| D0330 |
Panoramic radiographic image |
107 |
104 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
141 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
15 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
14 |
$1K |