| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
652 |
627 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,838 |
1,721 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
955 |
905 |
$25K |
| D1206 |
Topical application of fluoride varnish |
980 |
935 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,292 |
1,476 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
564 |
$20K |
| D0274 |
Bitewings - four radiographic images |
878 |
830 |
$17K |
| D1351 |
Sealant - per tooth |
421 |
58 |
$15K |
| D0330 |
Panoramic radiographic image |
422 |
402 |
$14K |
| D1110 |
Prophylaxis - adult |
337 |
326 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
38 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
285 |
$7K |
| D0272 |
Bitewings - two radiographic images |
247 |
237 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
26 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
140 |
$6K |
| D1999 |
|
498 |
394 |
$0.00 |