| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,615 |
1,614 |
$575K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
541 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
536 |
410 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
271 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
173 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
50 |
$19K |
| D1110 |
Prophylaxis - adult |
1,175 |
1,171 |
$1K |
| D0274 |
Bitewings - four radiographic images |
585 |
585 |
$756.00 |
| D1206 |
Topical application of fluoride varnish |
754 |
754 |
$442.00 |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$44.60 |
| D0330 |
Panoramic radiographic image |
147 |
147 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
501 |
483 |
$0.00 |
| D1120 |
Prophylaxis - child |
439 |
439 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |