| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,642 |
1,613 |
$117K |
| D1120 |
Prophylaxis - child |
1,794 |
1,767 |
$35K |
| D0272 |
Bitewings - two radiographic images |
922 |
902 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
100 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,965 |
1,930 |
$15K |
| D0330 |
Panoramic radiographic image |
102 |
96 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
868 |
836 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
952 |
552 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
145 |
30 |
$1K |
| D2140 |
|
38 |
24 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
26 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |