| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,887 |
3,885 |
$94K |
| D1120 |
Prophylaxis - child |
2,547 |
2,544 |
$91K |
| D1110 |
Prophylaxis - adult |
1,843 |
1,843 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
406 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,779 |
2,776 |
$58K |
| D0274 |
Bitewings - four radiographic images |
892 |
888 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
194 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
437 |
$20K |
| D0330 |
Panoramic radiographic image |
475 |
474 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
238 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
544 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
148 |
$6K |
| D0272 |
Bitewings - two radiographic images |
166 |
165 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
39 |
$498.33 |
| D0270 |
|
12 |
12 |
$85.95 |
| D1999 |
|
705 |
643 |
$0.00 |