| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
5,281 |
4,926 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,852 |
1,791 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
1,127 |
1,084 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,095 |
1,009 |
$6K |
| D1120 |
Prophylaxis - child |
499 |
472 |
$5K |
| D0274 |
Bitewings - four radiographic images |
597 |
564 |
$4K |
| D1110 |
Prophylaxis - adult |
226 |
213 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,259 |
1,138 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
42 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
95 |
$638.02 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
12 |
$238.64 |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$222.73 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$0.00 |