| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
924 |
892 |
$32K |
| D1110 |
Prophylaxis - adult |
559 |
530 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
116 |
$24K |
| D1206 |
Topical application of fluoride varnish |
651 |
610 |
$22K |
| D1120 |
Prophylaxis - child |
489 |
463 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
88 |
$12K |
| D0274 |
Bitewings - four radiographic images |
197 |
186 |
$6K |
| D0272 |
Bitewings - two radiographic images |
226 |
217 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
111 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
45 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
97 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$1K |
| D9910 |
|
31 |
31 |
$530.41 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
28 |
$494.74 |