| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,561 |
1,456 |
$60K |
| D1120 |
Prophylaxis - child |
1,505 |
1,448 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
370 |
224 |
$35K |
| D1206 |
Topical application of fluoride varnish |
951 |
914 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
164 |
$19K |
| D0274 |
Bitewings - four radiographic images |
698 |
630 |
$19K |
| D0330 |
Panoramic radiographic image |
355 |
331 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
163 |
159 |
$10K |
| D1351 |
Sealant - per tooth |
394 |
89 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
218 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
38 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
146 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
19 |
19 |
$607.72 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$224.33 |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
30 |
$100.00 |
| D1999 |
|
356 |
326 |
$0.00 |