| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,119 |
2,083 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,185 |
2,127 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,954 |
1,921 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
661 |
531 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,283 |
$27K |
| D1110 |
Prophylaxis - adult |
666 |
653 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,189 |
1,150 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
218 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
416 |
366 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,543 |
2,453 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,082 |
1,967 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
517 |
497 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
594 |
577 |
$9K |
| D4341 |
|
48 |
31 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
70 |
$5K |
| D0272 |
Bitewings - two radiographic images |
168 |
166 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$271.20 |
| D1330 |
|
55 |
55 |
$0.00 |