| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,245 |
1,200 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
722 |
514 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,237 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
445 |
342 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
867 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
511 |
234 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
911 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,275 |
1,192 |
$19K |
| D1110 |
Prophylaxis - adult |
466 |
413 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,671 |
2,452 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,540 |
2,005 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
244 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
651 |
606 |
$10K |
| D1351 |
Sealant - per tooth |
97 |
27 |
$4K |
| D2332 |
|
33 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
248 |
246 |
$2K |
| D0270 |
|
372 |
347 |
$2K |
| D0330 |
Panoramic radiographic image |
92 |
91 |
$2K |
| D2335 |
|
17 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
188 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$574.00 |