| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,336 |
2,180 |
$88K |
| D1351 |
Sealant - per tooth |
1,841 |
629 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,142 |
2,005 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
983 |
613 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,075 |
568 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,987 |
1,847 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,540 |
1,451 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,097 |
1,925 |
$30K |
| D1110 |
Prophylaxis - adult |
551 |
498 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,731 |
3,471 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,698 |
3,188 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
519 |
364 |
$17K |
| D1206 |
Topical application of fluoride varnish |
679 |
615 |
$16K |
| D0330 |
Panoramic radiographic image |
930 |
861 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
251 |
189 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
778 |
733 |
$7K |
| D0272 |
Bitewings - two radiographic images |
778 |
736 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
78 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
157 |
$2K |
| D2332 |
|
37 |
13 |
$2K |
| D0270 |
|
12 |
12 |
$67.20 |