| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,011 |
5,649 |
$106K |
| D1120 |
Prophylaxis - child |
3,983 |
3,721 |
$102K |
| D1110 |
Prophylaxis - adult |
2,879 |
2,669 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,530 |
6,123 |
$88K |
| D0330 |
Panoramic radiographic image |
1,965 |
1,825 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,801 |
2,607 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,216 |
2,040 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,314 |
1,189 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,234 |
1,127 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
182 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,286 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
139 |
$14K |
| D1351 |
Sealant - per tooth |
491 |
112 |
$11K |
| D1999 |
|
536 |
482 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
890 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
13 |
$965.60 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$831.20 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$730.80 |