| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
1,878 |
$53K |
| D1110 |
Prophylaxis - adult |
1,170 |
1,013 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,990 |
1,779 |
$38K |
| D0330 |
Panoramic radiographic image |
627 |
496 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,215 |
1,121 |
$28K |
| D1120 |
Prophylaxis - child |
511 |
443 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
419 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
52 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
30 |
$4K |
| D2140 |
|
66 |
17 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
13 |
$1K |