| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,890 |
1,876 |
$136K |
| D1120 |
Prophylaxis - child |
1,515 |
1,502 |
$72K |
| D1110 |
Prophylaxis - adult |
628 |
623 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
729 |
353 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,403 |
2,387 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
232 |
$15K |
| D0330 |
Panoramic radiographic image |
263 |
260 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
218 |
$4K |
| D0272 |
Bitewings - two radiographic images |
275 |
274 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D9430 |
|
50 |
50 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
74 |
$912.00 |