| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,790 |
3,599 |
$90K |
| D1110 |
Prophylaxis - adult |
2,079 |
1,962 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
517 |
394 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,944 |
2,788 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
605 |
392 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,281 |
1,191 |
$36K |
| D1120 |
Prophylaxis - child |
1,370 |
1,312 |
$35K |
| D0330 |
Panoramic radiographic image |
646 |
608 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
914 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
421 |
201 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
523 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,420 |
1,286 |
$18K |
| D0272 |
Bitewings - two radiographic images |
475 |
454 |
$8K |
| D1351 |
Sealant - per tooth |
281 |
70 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
15 |
$235.60 |