| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,961 |
3,840 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,383 |
4,244 |
$87K |
| D1120 |
Prophylaxis - child |
2,646 |
2,583 |
$87K |
| D1110 |
Prophylaxis - adult |
2,017 |
1,948 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
729 |
700 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
198 |
$32K |
| D0274 |
Bitewings - four radiographic images |
712 |
691 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,089 |
1,058 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
627 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
123 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
101 |
$16K |
| D1351 |
Sealant - per tooth |
208 |
66 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
193 |
$2K |
| D2140 |
|
32 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
69 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$522.46 |