| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,471 |
1,401 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
910 |
844 |
$21K |
| D1110 |
Prophylaxis - adult |
658 |
636 |
$21K |
| D1120 |
Prophylaxis - child |
968 |
915 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,243 |
1,185 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
395 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
928 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
266 |
$8K |
| D1206 |
Topical application of fluoride varnish |
234 |
220 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
41 |
$5K |
| D0274 |
Bitewings - four radiographic images |
328 |
317 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
20 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
13 |
$1K |
| D1999 |
|
24 |
22 |
$330.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
177 |
152 |
$115.00 |