| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,348 |
1,259 |
$66K |
| D1110 |
Prophylaxis - adult |
1,091 |
1,077 |
$46K |
| D1120 |
Prophylaxis - child |
1,562 |
1,506 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,135 |
2,061 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
982 |
970 |
$26K |
| D0330 |
Panoramic radiographic image |
292 |
250 |
$20K |
| D1351 |
Sealant - per tooth |
675 |
188 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
122 |
$19K |
| D0274 |
Bitewings - four radiographic images |
503 |
496 |
$16K |
| D0272 |
Bitewings - two radiographic images |
527 |
510 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
115 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
47 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
130 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
65 |
28 |
$364.36 |
| D9996 |
|
87 |
84 |
$0.00 |
| D0190 |
|
58 |
57 |
$0.00 |