| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
974 |
864 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
590 |
362 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
511 |
248 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,133 |
1,060 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
804 |
684 |
$21K |
| D1110 |
Prophylaxis - adult |
506 |
465 |
$19K |
| D1351 |
Sealant - per tooth |
338 |
155 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
759 |
659 |
$18K |
| D4341 |
|
117 |
52 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
623 |
588 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
345 |
230 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
182 |
128 |
$10K |
| D0274 |
Bitewings - four radiographic images |
563 |
472 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,251 |
989 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
323 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
916 |
708 |
$3K |
| D0272 |
Bitewings - two radiographic images |
163 |
141 |
$1K |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$832.00 |