| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,979 |
3,425 |
$94K |
| D1120 |
Prophylaxis - child |
4,625 |
3,994 |
$84K |
| D1351 |
Sealant - per tooth |
6,526 |
1,146 |
$79K |
| D1206 |
Topical application of fluoride varnish |
5,951 |
5,133 |
$70K |
| D1110 |
Prophylaxis - adult |
1,669 |
1,463 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,961 |
2,573 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
707 |
637 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,724 |
1,498 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
293 |
$16K |
| D0330 |
Panoramic radiographic image |
1,265 |
1,085 |
$15K |
| D0274 |
Bitewings - four radiographic images |
839 |
763 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
140 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
712 |
614 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
219 |
196 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
337 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
205 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$200.82 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$0.00 |