| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,691 |
3,270 |
$143K |
| D1120 |
Prophylaxis - child |
4,514 |
3,352 |
$99K |
| D0330 |
Panoramic radiographic image |
2,080 |
1,463 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,531 |
1,884 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,431 |
1,985 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,612 |
1,308 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
600 |
250 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
121 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,075 |
1,604 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,340 |
803 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
692 |
456 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,746 |
1,121 |
$17K |
| D1351 |
Sealant - per tooth |
563 |
58 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
42 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
127 |
57 |
$4K |
| D1110 |
Prophylaxis - adult |
22 |
18 |
$31.62 |