| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,795 |
3,480 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
4,531 |
4,045 |
$147K |
| D1110 |
Prophylaxis - adult |
2,790 |
2,477 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,887 |
4,383 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
802 |
531 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,754 |
2,340 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
570 |
404 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,113 |
1,816 |
$97K |
| D0330 |
Panoramic radiographic image |
834 |
738 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
848 |
706 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,164 |
1,770 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
675 |
561 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,320 |
985 |
$18K |
| D1206 |
Topical application of fluoride varnish |
541 |
502 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
81 |
$8K |
| D0272 |
Bitewings - two radiographic images |
229 |
202 |
$7K |
| D4355 |
|
25 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$3K |
| D0603 |
|
2,776 |
2,539 |
$0.00 |
| D0602 |
|
1,991 |
1,808 |
$0.00 |
| D0601 |
|
119 |
117 |
$0.00 |
| D1330 |
|
314 |
286 |
$0.00 |