| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
300 |
278 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
271 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
178 |
159 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
667 |
611 |
$7K |
| D0274 |
Bitewings - four radiographic images |
311 |
283 |
$6K |
| D1351 |
Sealant - per tooth |
275 |
41 |
$6K |
| D1120 |
Prophylaxis - child |
146 |
135 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
296 |
271 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
44 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
549 |
443 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
33 |
$2K |
| D1110 |
Prophylaxis - adult |
76 |
72 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
89 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
12 |
$1K |
| D1999 |
|
245 |
203 |
$0.00 |