| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,346 |
3,310 |
$34K |
| D1110 |
Prophylaxis - adult |
2,834 |
2,806 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
851 |
842 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,047 |
616 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
7,042 |
6,105 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,938 |
2,907 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
467 |
302 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,675 |
4,209 |
$6K |
| D0274 |
Bitewings - four radiographic images |
2,106 |
2,076 |
$6K |
| D0330 |
Panoramic radiographic image |
1,370 |
1,358 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
379 |
379 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
145 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
294 |
$3K |
| D0270 |
|
1,362 |
1,237 |
$2K |
| D1120 |
Prophylaxis - child |
167 |
167 |
$759.00 |
| D2330 |
|
14 |
12 |
$266.00 |