| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,233 |
8,098 |
$244K |
| D1120 |
Prophylaxis - child |
5,289 |
5,201 |
$228K |
| D1110 |
Prophylaxis - adult |
3,691 |
3,634 |
$227K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,897 |
7,767 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,359 |
796 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
824 |
504 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
178 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,376 |
1,354 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
437 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,015 |
1,964 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,779 |
1,752 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
217 |
207 |
$10K |
| D1330 |
|
333 |
321 |
$2K |
| D0272 |
Bitewings - two radiographic images |
32 |
32 |
$480.00 |