| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,317 |
2,314 |
$170K |
| D1120 |
Prophylaxis - child |
2,467 |
2,462 |
$44K |
| D2140 |
|
619 |
205 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,500 |
1,499 |
$22K |
| D1206 |
Topical application of fluoride varnish |
2,297 |
2,292 |
$19K |
| D1351 |
Sealant - per tooth |
395 |
79 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
188 |
$15K |
| D0274 |
Bitewings - four radiographic images |
445 |
444 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
338 |
$6K |
| D0330 |
Panoramic radiographic image |
125 |
125 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
36 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
191 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$1K |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$0.00 |