| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,243 |
1,160 |
$43K |
| D1110 |
Prophylaxis - adult |
926 |
876 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
469 |
243 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
960 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
646 |
550 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,076 |
1,035 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
412 |
$16K |
| D4346 |
|
112 |
106 |
$15K |
| D1206 |
Topical application of fluoride varnish |
816 |
779 |
$15K |
| D1120 |
Prophylaxis - child |
292 |
275 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
36 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
301 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
14 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
70 |
64 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$272.91 |