| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,702 |
2,616 |
$0.00 |
| D1310 |
|
2,458 |
2,403 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
3,544 |
3,162 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,737 |
2,558 |
$0.00 |
| D1330 |
|
4,065 |
3,903 |
$0.00 |
| D0603 |
|
2,192 |
2,109 |
$0.00 |
| D0601 |
|
671 |
663 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
515 |
$0.00 |
| D1351 |
Sealant - per tooth |
102 |
64 |
$0.00 |
| D1320 |
|
179 |
172 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
98 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
165 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
82 |
81 |
$0.00 |
| D0602 |
|
71 |
69 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$0.00 |
| D1354 |
|
1,126 |
500 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
990 |
970 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,191 |
1,164 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,402 |
1,378 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$0.00 |
| D0191 |
|
192 |
191 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
764 |
715 |
$0.00 |
| D0330 |
Panoramic radiographic image |
350 |
343 |
$0.00 |
| D1999 |
|
29 |
29 |
$0.00 |