| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,089 |
4,059 |
$14K |
| D1110 |
Prophylaxis - adult |
2,389 |
2,371 |
$12K |
| D1120 |
Prophylaxis - child |
2,176 |
2,156 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,040 |
884 |
$11K |
| D0274 |
Bitewings - four radiographic images |
2,645 |
2,620 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
702 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
910 |
478 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,620 |
1,579 |
$6K |
| D1206 |
Topical application of fluoride varnish |
2,119 |
2,108 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
574 |
574 |
$5K |
| D4341 |
|
275 |
129 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
972 |
961 |
$5K |
| D4910 |
|
677 |
669 |
$4K |
| D0272 |
Bitewings - two radiographic images |
629 |
623 |
$2K |
| D0330 |
Panoramic radiographic image |
995 |
977 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
115 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,082 |
998 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
464 |
$1K |
| D2331 |
|
47 |
39 |
$560.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$52.50 |
| D1330 |
|
93 |
93 |
$0.00 |