| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
830 |
787 |
$22K |
| D1120 |
Prophylaxis - child |
570 |
539 |
$22K |
| D0999 |
Unspecified diagnostic procedure, by report |
177 |
142 |
$19K |
| D1206 |
Topical application of fluoride varnish |
495 |
463 |
$12K |
| D1110 |
Prophylaxis - adult |
214 |
205 |
$10K |
| D0274 |
Bitewings - four radiographic images |
448 |
434 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
303 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
79 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
736 |
707 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
79 |
$4K |
| D1351 |
Sealant - per tooth |
63 |
36 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
657 |
633 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
30 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
107 |
$2K |
| D0272 |
Bitewings - two radiographic images |
159 |
146 |
$2K |
| D0330 |
Panoramic radiographic image |
68 |
63 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
59 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$896.78 |
| D0602 |
|
60 |
57 |
$600.00 |
| D0601 |
|
30 |
30 |
$337.50 |