| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,372 |
1,350 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,469 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,320 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
411 |
$31K |
| D1351 |
Sealant - per tooth |
281 |
196 |
$21K |
| D0274 |
Bitewings - four radiographic images |
990 |
969 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
247 |
$11K |
| D0330 |
Panoramic radiographic image |
394 |
388 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
401 |
$8K |
| D9110 |
|
138 |
132 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
90 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
45 |
$6K |
| D1110 |
Prophylaxis - adult |
118 |
116 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
40 |
$4K |
| D0272 |
Bitewings - two radiographic images |
419 |
408 |
$4K |
| D4342 |
|
34 |
17 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
522 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
421 |
385 |
$3K |
| D9630 |
|
14 |
13 |
$305.50 |
| D1999 |
|
420 |
343 |
$0.00 |