| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,056 |
7,016 |
$384K |
| D1110 |
Prophylaxis - adult |
2,791 |
2,766 |
$231K |
| D1120 |
Prophylaxis - child |
5,612 |
5,586 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,597 |
1,584 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,272 |
8,223 |
$95K |
| D0274 |
Bitewings - four radiographic images |
4,575 |
4,553 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,460 |
6,527 |
$77K |
| D9920 |
|
353 |
348 |
$42K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,356 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
520 |
$37K |
| D9430 |
|
1,132 |
1,117 |
$35K |
| D9993 |
|
552 |
552 |
$34K |
| D1310 |
|
755 |
755 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,165 |
2,131 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,443 |
1,441 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
79 |
$7K |
| D0601 |
|
281 |
281 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$1K |