| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,113 |
1,067 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,731 |
1,650 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,107 |
1,071 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,500 |
1,433 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
860 |
828 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
147 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
202 |
117 |
$17K |
| D1351 |
Sealant - per tooth |
268 |
100 |
$15K |
| D1110 |
Prophylaxis - adult |
322 |
315 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,987 |
1,870 |
$11K |
| D4341 |
|
39 |
24 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
140 |
73 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,481 |
1,321 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
258 |
$4K |
| D0330 |
Panoramic radiographic image |
197 |
192 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$903.70 |
| D0272 |
Bitewings - two radiographic images |
56 |
53 |
$548.37 |