| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,196 |
2,097 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,036 |
2,641 |
$81K |
| D1110 |
Prophylaxis - adult |
1,234 |
1,169 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
698 |
430 |
$41K |
| D4341 |
|
274 |
98 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,384 |
2,199 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,782 |
1,650 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,480 |
1,435 |
$36K |
| D1351 |
Sealant - per tooth |
348 |
209 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
340 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
253 |
178 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,562 |
3,245 |
$19K |
| D1206 |
Topical application of fluoride varnish |
695 |
637 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,049 |
989 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
345 |
282 |
$15K |
| D0330 |
Panoramic radiographic image |
831 |
782 |
$15K |
| D5110 |
|
41 |
39 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,126 |
2,847 |
$11K |
| D4342 |
|
38 |
20 |
$5K |
| D5120 |
|
14 |
14 |
$5K |
| D0272 |
Bitewings - two radiographic images |
461 |
436 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
154 |
$3K |
| D2940 |
|
12 |
12 |
$158.20 |
| D1999 |
|
574 |
541 |
$0.00 |