| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
811 |
673 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
914 |
774 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
377 |
245 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
720 |
595 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
270 |
152 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
373 |
243 |
$14K |
| D1110 |
Prophylaxis - adult |
386 |
346 |
$14K |
| D1351 |
Sealant - per tooth |
155 |
88 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
590 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
144 |
102 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
421 |
363 |
$11K |
| D0274 |
Bitewings - four radiographic images |
511 |
445 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,041 |
872 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
259 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
849 |
704 |
$3K |
| D9110 |
|
34 |
32 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
87 |
75 |
$705.00 |