| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,972 |
3,711 |
$101K |
| D1110 |
Prophylaxis - adult |
2,079 |
1,914 |
$100K |
| D1206 |
Topical application of fluoride varnish |
3,165 |
2,980 |
$62K |
| D1120 |
Prophylaxis - child |
1,835 |
1,680 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
401 |
230 |
$52K |
| D0274 |
Bitewings - four radiographic images |
587 |
545 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
108 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
214 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
90 |
$7K |
| D4346 |
|
89 |
88 |
$6K |
| D1351 |
Sealant - per tooth |
323 |
41 |
$5K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
135 |
$2K |
| D0272 |
Bitewings - two radiographic images |
72 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
30 |
$787.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
13 |
$429.00 |
| D1330 |
|
15 |
13 |
$105.00 |