| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,112 |
1,926 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
1,844 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,965 |
1,784 |
$47K |
| D1351 |
Sealant - per tooth |
690 |
313 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
633 |
456 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
601 |
362 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,258 |
1,139 |
$26K |
| D1110 |
Prophylaxis - adult |
777 |
704 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
1,006 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
401 |
300 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
210 |
133 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,583 |
2,335 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,289 |
2,018 |
$10K |
| D0330 |
Panoramic radiographic image |
368 |
344 |
$7K |
| D0272 |
Bitewings - two radiographic images |
829 |
734 |
$7K |
| D5110 |
|
17 |
12 |
$5K |
| D2332 |
|
35 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
182 |
171 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
102 |
$941.47 |
| D0270 |
|
12 |
12 |
$67.20 |