| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,286 |
7,051 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
6,150 |
5,931 |
$171K |
| D1206 |
Topical application of fluoride varnish |
6,086 |
5,925 |
$159K |
| D1351 |
Sealant - per tooth |
1,491 |
931 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,603 |
1,276 |
$98K |
| D9110 |
|
842 |
796 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,399 |
2,319 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,303 |
1,273 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,421 |
2,336 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
500 |
472 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,064 |
1,039 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
230 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,781 |
1,740 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
56 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
27 |
$388.80 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$295.71 |
| D1999 |
|
31 |
31 |
$0.00 |