| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0190 |
|
5,223 |
4,997 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
876 |
812 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
926 |
921 |
$38K |
| D1351 |
Sealant - per tooth |
2,810 |
1,426 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,295 |
1,282 |
$30K |
| D0274 |
Bitewings - four radiographic images |
813 |
809 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
426 |
402 |
$26K |
| D1206 |
Topical application of fluoride varnish |
6,242 |
6,013 |
$22K |
| D1110 |
Prophylaxis - adult |
488 |
487 |
$22K |
| D1120 |
Prophylaxis - child |
454 |
452 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
61 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
118 |
118 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
121 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| D0272 |
Bitewings - two radiographic images |
996 |
988 |
$156.12 |
| D0220 |
Intraoral - periapical first radiographic image |
2,352 |
2,319 |
$89.23 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,053 |
2,040 |
$0.00 |
| D1330 |
|
1,024 |
1,021 |
$0.00 |