| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,065 |
4,884 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,329 |
3,268 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
660 |
$102K |
| D1206 |
Topical application of fluoride varnish |
4,872 |
3,861 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,324 |
1,868 |
$70K |
| D1351 |
Sealant - per tooth |
3,104 |
363 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,134 |
459 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,338 |
550 |
$59K |
| D0330 |
Panoramic radiographic image |
2,014 |
1,580 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,985 |
1,754 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,963 |
1,509 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,411 |
2,842 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,826 |
1,348 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,413 |
1,194 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
221 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,063 |
869 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
39 |
$6K |
| D1999 |
|
35 |
31 |
$0.00 |