| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,333 |
5,199 |
$170K |
| D1120 |
Prophylaxis - child |
7,193 |
5,986 |
$144K |
| D1351 |
Sealant - per tooth |
6,614 |
983 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,197 |
5,990 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,372 |
2,088 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
993 |
589 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
479 |
$65K |
| D0330 |
Panoramic radiographic image |
1,566 |
1,323 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,045 |
972 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,404 |
1,168 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
142 |
$16K |
| D1206 |
Topical application of fluoride varnish |
841 |
753 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
86 |
$5K |
| D2332 |
|
39 |
28 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
99 |
$1K |
| D1110 |
Prophylaxis - adult |
41 |
27 |
$637.00 |