| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,386 |
6,197 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
6,865 |
6,645 |
$190K |
| D1351 |
Sealant - per tooth |
2,061 |
1,355 |
$178K |
| D1206 |
Topical application of fluoride varnish |
6,066 |
5,897 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,622 |
1,283 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,216 |
892 |
$82K |
| D0274 |
Bitewings - four radiographic images |
4,125 |
4,010 |
$72K |
| D1110 |
Prophylaxis - adult |
1,389 |
1,375 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
8,944 |
8,543 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,022 |
1,961 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,835 |
7,495 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
588 |
504 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,256 |
1,228 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
236 |
193 |
$19K |
| D4341 |
|
84 |
56 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,784 |
1,708 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
197 |
164 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
175 |
$5K |
| D4342 |
|
13 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
143 |
$2K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$1K |
| D2332 |
|
20 |
12 |
$1K |
| D0270 |
|
94 |
93 |
$522.70 |
| D1999 |
|
179 |
167 |
$0.00 |