| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,260 |
2,251 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,393 |
2,383 |
$47K |
| D1120 |
Prophylaxis - child |
1,511 |
1,504 |
$41K |
| D1110 |
Prophylaxis - adult |
801 |
799 |
$29K |
| D1351 |
Sealant - per tooth |
1,032 |
199 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
272 |
$23K |
| D0274 |
Bitewings - four radiographic images |
604 |
601 |
$18K |
| D0272 |
Bitewings - two radiographic images |
888 |
879 |
$16K |
| D0330 |
Panoramic radiographic image |
285 |
284 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
120 |
$10K |
| D0603 |
|
964 |
960 |
$10K |
| D1330 |
|
1,345 |
1,342 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
96 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
197 |
$5K |
| D1310 |
|
191 |
191 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
204 |
$2K |
| D0602 |
|
137 |
137 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$965.00 |
| D0240 |
|
47 |
38 |
$841.38 |
| D9920 |
|
12 |
12 |
$665.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$120.45 |