| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,408 |
2,167 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,717 |
882 |
$73K |
| D1120 |
Prophylaxis - child |
1,276 |
1,092 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,251 |
1,075 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
340 |
231 |
$20K |
| D0330 |
Panoramic radiographic image |
970 |
858 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
370 |
263 |
$19K |
| D1110 |
Prophylaxis - adult |
573 |
471 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
948 |
796 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
290 |
$16K |
| D0274 |
Bitewings - four radiographic images |
961 |
818 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,509 |
2,096 |
$11K |
| D0272 |
Bitewings - two radiographic images |
680 |
593 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
423 |
$10K |
| D2394 |
|
157 |
126 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,252 |
1,788 |
$8K |
| D1351 |
Sealant - per tooth |
128 |
66 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
60 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
350 |
323 |
$4K |
| D2332 |
|
39 |
30 |
$3K |
| D2335 |
|
34 |
27 |
$2K |