| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,254 |
1,210 |
$28K |
| D0274 |
Bitewings - four radiographic images |
843 |
811 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,183 |
1,128 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
194 |
$22K |
| D1120 |
Prophylaxis - child |
502 |
498 |
$21K |
| D1110 |
Prophylaxis - adult |
715 |
669 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
515 |
486 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
849 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
145 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
53 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
175 |
$2K |
| D2394 |
|
26 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
20 |
16 |
$647.28 |