| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,500 |
5,500 |
$113K |
| D1120 |
Prophylaxis - child |
3,783 |
3,783 |
$111K |
| D1110 |
Prophylaxis - adult |
2,248 |
2,248 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,064 |
820 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,969 |
5,969 |
$88K |
| D0330 |
Panoramic radiographic image |
1,332 |
1,332 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
896 |
666 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,177 |
1,177 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,483 |
1,483 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,026 |
1,004 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
162 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
276 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
106 |
$3K |
| D1351 |
Sealant - per tooth |
100 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$1K |
| D2330 |
|
18 |
14 |
$1K |