| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,591 |
1,578 |
$522K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
697 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
125 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
140 |
$37K |
| D5899 |
|
87 |
69 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
99 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
17 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
727 |
704 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
952 |
943 |
$0.00 |
| D0330 |
Panoramic radiographic image |
227 |
221 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,570 |
1,556 |
$0.00 |
| D1120 |
Prophylaxis - child |
105 |
104 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
661 |
654 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$0.00 |