| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,597 |
1,547 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,152 |
2,082 |
$59K |
| D4341 |
|
348 |
178 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,544 |
1,478 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
401 |
209 |
$32K |
| D1110 |
Prophylaxis - adult |
646 |
632 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,372 |
1,334 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
934 |
896 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,476 |
1,407 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,490 |
3,305 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
605 |
587 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
228 |
167 |
$15K |
| D0330 |
Panoramic radiographic image |
647 |
628 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,654 |
2,351 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
157 |
$10K |
| D1206 |
Topical application of fluoride varnish |
219 |
216 |
$6K |
| D1351 |
Sealant - per tooth |
47 |
28 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
20 |
$4K |
| D9110 |
|
17 |
16 |
$880.00 |
| D0272 |
Bitewings - two radiographic images |
83 |
82 |
$738.72 |
| D0270 |
|
132 |
132 |
$724.22 |