| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,891 |
1,765 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
691 |
475 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
926 |
475 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,199 |
2,077 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,669 |
1,504 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,797 |
1,685 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
464 |
359 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,065 |
997 |
$26K |
| D1110 |
Prophylaxis - adult |
704 |
644 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,290 |
2,593 |
$23K |
| D1351 |
Sealant - per tooth |
391 |
170 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,361 |
3,104 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
788 |
722 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
367 |
$9K |
| D0330 |
Panoramic radiographic image |
364 |
346 |
$7K |
| D0272 |
Bitewings - two radiographic images |
478 |
439 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
237 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
51 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$2K |
| D9110 |
|
13 |
12 |
$715.00 |