| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,589 |
5,554 |
$138K |
| D1110 |
Prophylaxis - adult |
3,451 |
3,395 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,660 |
1,040 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,401 |
856 |
$84K |
| D1120 |
Prophylaxis - child |
3,476 |
3,428 |
$78K |
| D1206 |
Topical application of fluoride varnish |
4,136 |
4,060 |
$75K |
| D0330 |
Panoramic radiographic image |
2,030 |
1,968 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,355 |
2,163 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
6,262 |
5,963 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
1,057 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,339 |
2,322 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,265 |
2,206 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,747 |
1,722 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
399 |
107 |
$15K |
| D1351 |
Sealant - per tooth |
721 |
298 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,078 |
4,195 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
29 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
37 |
$4K |
| D4341 |
|
27 |
12 |
$1K |