| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,526 |
1,512 |
$54K |
| D1120 |
Prophylaxis - child |
1,110 |
1,106 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
293 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,770 |
1,756 |
$47K |
| D1110 |
Prophylaxis - adult |
710 |
699 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,001 |
1,959 |
$42K |
| D0274 |
Bitewings - four radiographic images |
542 |
541 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,418 |
1,393 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
126 |
$22K |
| D0272 |
Bitewings - two radiographic images |
651 |
650 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
287 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
265 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
58 |
$14K |
| D1351 |
Sealant - per tooth |
434 |
130 |
$13K |
| D0330 |
Panoramic radiographic image |
143 |
143 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
261 |
$11K |