| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,336 |
2,242 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,417 |
2,327 |
$66K |
| D1120 |
Prophylaxis - child |
1,853 |
1,794 |
$55K |
| D1110 |
Prophylaxis - adult |
1,064 |
1,008 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,665 |
3,484 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
321 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,579 |
1,528 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
898 |
855 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,589 |
2,452 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,107 |
1,051 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
57 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
481 |
463 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
41 |
$6K |
| D0330 |
Panoramic radiographic image |
173 |
148 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
67 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
41 |
$4K |
| D0272 |
Bitewings - two radiographic images |
129 |
110 |
$2K |