| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,258 |
4,027 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
3,999 |
3,772 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,744 |
3,552 |
$92K |
| D1351 |
Sealant - per tooth |
563 |
346 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
629 |
446 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,045 |
1,913 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
562 |
410 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,046 |
3,769 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
994 |
939 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,693 |
3,430 |
$16K |
| D1110 |
Prophylaxis - adult |
387 |
367 |
$13K |
| D0272 |
Bitewings - two radiographic images |
806 |
744 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
357 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
221 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
65 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
16 |
$1K |
| D0270 |
|
181 |
173 |
$968.80 |
| D1999 |
|
62 |
55 |
$0.00 |