| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,395 |
1,374 |
$20K |
| D1120 |
Prophylaxis - child |
932 |
919 |
$20K |
| D1110 |
Prophylaxis - adult |
745 |
732 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,405 |
2,295 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,017 |
997 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,198 |
1,181 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
651 |
640 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,512 |
1,864 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
55 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
115 |
$9K |
| D0272 |
Bitewings - two radiographic images |
655 |
648 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
444 |
411 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
85 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
16 |
$727.98 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$395.85 |
| D0270 |
|
12 |
12 |
$67.20 |
| D1999 |
|
478 |
419 |
$0.00 |