| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
483 |
395 |
$13K |
| D1120 |
Prophylaxis - child |
495 |
382 |
$11K |
| D1206 |
Topical application of fluoride varnish |
501 |
388 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
31 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
153 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
79 |
$1K |
| D0272 |
Bitewings - two radiographic images |
135 |
111 |
$853.93 |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$638.08 |
| D9310 |
|
18 |
18 |
$307.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
43 |
$264.32 |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
16 |
$217.76 |
| D0330 |
Panoramic radiographic image |
37 |
12 |
$0.00 |