| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,615 |
4,452 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
4,601 |
4,398 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,695 |
3,567 |
$93K |
| D1351 |
Sealant - per tooth |
1,045 |
680 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
501 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
738 |
421 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,845 |
1,752 |
$31K |
| D1110 |
Prophylaxis - adult |
543 |
494 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
859 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,969 |
2,780 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,061 |
1,930 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,001 |
957 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
446 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
164 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
55 |
$4K |
| D1206 |
Topical application of fluoride varnish |
128 |
128 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
72 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$696.60 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$203.40 |
| D1999 |
|
35 |
34 |
$0.00 |