| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,563 |
5,942 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
4,129 |
3,628 |
$136K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,375 |
543 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,593 |
852 |
$125K |
| D0330 |
Panoramic radiographic image |
2,949 |
2,624 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,701 |
4,298 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
699 |
447 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,229 |
3,858 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,445 |
1,229 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,531 |
1,384 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
321 |
$35K |
| D1351 |
Sealant - per tooth |
1,384 |
310 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,516 |
1,347 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,832 |
2,413 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
299 |
162 |
$20K |
| D2394 |
|
118 |
86 |
$17K |
| D0272 |
Bitewings - two radiographic images |
880 |
781 |
$15K |
| D1110 |
Prophylaxis - adult |
689 |
598 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
36 |
$405.67 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$66.32 |
| D3120 |
|
51 |
32 |
$0.00 |