| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,199 |
5,107 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
483 |
$102K |
| D1120 |
Prophylaxis - child |
3,115 |
3,066 |
$93K |
| D1110 |
Prophylaxis - adult |
1,785 |
1,754 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,858 |
4,778 |
$73K |
| D0330 |
Panoramic radiographic image |
1,084 |
1,065 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,004 |
999 |
$30K |
| D0274 |
Bitewings - four radiographic images |
919 |
898 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,433 |
1,412 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,612 |
1,550 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
171 |
84 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
92 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
987 |
705 |
$7K |
| D2140 |
|
79 |
52 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$183.17 |
| D0601 |
|
16 |
14 |
$146.40 |
| D0603 |
|
14 |
14 |
$128.10 |
| D0602 |
|
12 |
12 |
$109.80 |