| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
721 |
692 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
832 |
804 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
660 |
639 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
533 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
211 |
139 |
$12K |
| D0274 |
Bitewings - four radiographic images |
596 |
568 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
126 |
$8K |
| D1110 |
Prophylaxis - adult |
269 |
263 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
945 |
$6K |
| D1351 |
Sealant - per tooth |
68 |
43 |
$5K |
| D0330 |
Panoramic radiographic image |
243 |
225 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
973 |
772 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
41 |
$4K |
| D4341 |
|
23 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
315 |
299 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
132 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
55 |
52 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$899.76 |
| D1999 |
|
283 |
248 |
$0.00 |