| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,346 |
2,264 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,854 |
2,821 |
$78K |
| D1110 |
Prophylaxis - adult |
1,459 |
1,436 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,843 |
2,625 |
$66K |
| D4341 |
|
282 |
135 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,974 |
1,937 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
481 |
349 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,235 |
2,128 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,453 |
1,285 |
$30K |
| D0330 |
Panoramic radiographic image |
1,361 |
1,314 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
241 |
148 |
$20K |
| D1351 |
Sealant - per tooth |
209 |
107 |
$19K |
| D4342 |
|
122 |
67 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
712 |
701 |
$13K |
| D2750 |
|
41 |
38 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
43 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
876 |
830 |
$5K |
| D2950 |
|
69 |
57 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
55 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
32 |
$2K |
| D0272 |
Bitewings - two radiographic images |
121 |
109 |
$1K |
| D1206 |
Topical application of fluoride varnish |
47 |
40 |
$1K |
| D9110 |
|
15 |
15 |
$825.00 |
| D4910 |
|
13 |
13 |
$804.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
29 |
$96.90 |