| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,653 |
5,632 |
$297K |
| D1120 |
Prophylaxis - child |
6,204 |
6,182 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,154 |
3,146 |
$195K |
| D1110 |
Prophylaxis - adult |
1,996 |
1,988 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
3,107 |
3,096 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,426 |
958 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,589 |
6,566 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,206 |
747 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,992 |
2,952 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,157 |
2,151 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
382 |
282 |
$21K |
| D1351 |
Sealant - per tooth |
937 |
213 |
$21K |
| D0330 |
Panoramic radiographic image |
439 |
438 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
414 |
405 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
54 |
54 |
$3K |
| D2330 |
|
24 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
63 |
$287.55 |