| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,709 |
3,483 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
4,269 |
3,972 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,508 |
3,300 |
$87K |
| D1351 |
Sealant - per tooth |
750 |
278 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,759 |
1,620 |
$28K |
| D1110 |
Prophylaxis - adult |
537 |
480 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
159 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,390 |
2,195 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
595 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,964 |
1,685 |
$8K |
| D0272 |
Bitewings - two radiographic images |
774 |
719 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
386 |
371 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
71 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
135 |
$4K |
| D1206 |
Topical application of fluoride varnish |
117 |
104 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
49 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
18 |
$2K |
| D1999 |
|
438 |
390 |
$0.00 |