| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,190 |
1,183 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,632 |
1,611 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
669 |
465 |
$43K |
| D1110 |
Prophylaxis - adult |
788 |
776 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
596 |
342 |
$34K |
| D1351 |
Sealant - per tooth |
626 |
247 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,130 |
1,124 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,478 |
1,460 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
907 |
898 |
$22K |
| D4341 |
|
99 |
56 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,071 |
2,022 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
208 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,104 |
1,557 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
88 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
435 |
424 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
65 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
158 |
$2K |
| D0272 |
Bitewings - two radiographic images |
173 |
173 |
$2K |
| D2940 |
|
46 |
40 |
$519.80 |
| D1999 |
|
524 |
493 |
$0.00 |