| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,483 |
5,240 |
$132K |
| D1110 |
Prophylaxis - adult |
3,661 |
3,482 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,442 |
923 |
$109K |
| D1120 |
Prophylaxis - child |
2,437 |
2,315 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,638 |
1,563 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,314 |
753 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,481 |
2,358 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
2,438 |
2,266 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,281 |
2,171 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
547 |
295 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
349 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,130 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
604 |
355 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
49 |
$4K |
| D2140 |
|
41 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
16 |
$2K |