| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,980 |
13,748 |
$359K |
| D1110 |
Prophylaxis - adult |
8,045 |
7,872 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,399 |
1,795 |
$252K |
| D1120 |
Prophylaxis - child |
8,645 |
8,451 |
$236K |
| D0330 |
Panoramic radiographic image |
3,349 |
3,225 |
$192K |
| D0274 |
Bitewings - four radiographic images |
4,494 |
4,380 |
$145K |
| D1206 |
Topical application of fluoride varnish |
8,422 |
8,173 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,858 |
2,721 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,355 |
1,080 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
7,070 |
6,781 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,189 |
6,087 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,406 |
5,157 |
$76K |
| D0272 |
Bitewings - two radiographic images |
3,627 |
3,544 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
529 |
408 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,836 |
1,774 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
795 |
390 |
$49K |
| D2331 |
|
435 |
295 |
$35K |
| D1351 |
Sealant - per tooth |
355 |
76 |
$9K |
| D2330 |
|
95 |
71 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
222 |
118 |
$4K |
| D2332 |
|
15 |
13 |
$1K |