| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,410 |
1,399 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
764 |
567 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,398 |
1,387 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,085 |
1,080 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
922 |
914 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,181 |
1,170 |
$22K |
| D1110 |
Prophylaxis - adult |
436 |
434 |
$20K |
| D4341 |
|
137 |
64 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
352 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
143 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
535 |
516 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,307 |
1,260 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
208 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
952 |
878 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
42 |
$3K |
| D1351 |
Sealant - per tooth |
47 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
48 |
$1K |
| D0272 |
Bitewings - two radiographic images |
115 |
115 |
$1K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$899.16 |
| D0270 |
|
157 |
153 |
$868.00 |
| D9310 |
|
13 |
13 |
$205.20 |