| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,958 |
3,644 |
$92K |
| D1110 |
Prophylaxis - adult |
2,706 |
2,499 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
847 |
560 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
900 |
352 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,745 |
2,451 |
$36K |
| D1206 |
Topical application of fluoride varnish |
2,164 |
1,975 |
$32K |
| D1120 |
Prophylaxis - child |
1,291 |
1,163 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,073 |
985 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,775 |
1,995 |
$30K |
| D0330 |
Panoramic radiographic image |
333 |
311 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
297 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
124 |
$8K |
| D0272 |
Bitewings - two radiographic images |
412 |
329 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
52 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
104 |
$4K |
| D4355 |
|
29 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$1K |