| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,623 |
2,516 |
$96K |
| D1351 |
Sealant - per tooth |
1,594 |
711 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
2,884 |
2,724 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,405 |
768 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,368 |
2,272 |
$55K |
| D1110 |
Prophylaxis - adult |
938 |
921 |
$40K |
| D4341 |
|
294 |
191 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,909 |
1,803 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,526 |
2,377 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
530 |
368 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
518 |
427 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,682 |
4,328 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,378 |
3,927 |
$19K |
| D0330 |
Panoramic radiographic image |
971 |
935 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
766 |
708 |
$12K |
| D0272 |
Bitewings - two radiographic images |
862 |
827 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
486 |
$7K |
| D4342 |
|
118 |
65 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
139 |
136 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
80 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$928.80 |
| D1999 |
|
12 |
12 |
$0.00 |
| D0270 |
|
14 |
14 |
$0.00 |
| D0601 |
|
64 |
64 |
$0.00 |