| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,601 |
2,479 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,377 |
2,290 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
769 |
536 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,739 |
1,647 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,063 |
1,967 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,258 |
1,180 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,286 |
1,249 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
755 |
534 |
$28K |
| D1110 |
Prophylaxis - adult |
643 |
612 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,107 |
2,874 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,953 |
2,578 |
$13K |
| D1351 |
Sealant - per tooth |
108 |
54 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
381 |
353 |
$6K |
| D4341 |
|
29 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
77 |
$4K |
| D0272 |
Bitewings - two radiographic images |
298 |
291 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
101 |
$2K |
| D9110 |
|
13 |
12 |
$715.00 |
| D0270 |
|
15 |
14 |
$72.80 |