| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,156 |
2,034 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,141 |
1,985 |
$59K |
| D1351 |
Sealant - per tooth |
525 |
300 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,483 |
1,444 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,464 |
1,329 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
470 |
222 |
$24K |
| D9110 |
|
336 |
314 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,855 |
2,625 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
620 |
541 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
704 |
625 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
178 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,453 |
2,244 |
$13K |
| D1110 |
Prophylaxis - adult |
317 |
276 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
392 |
$7K |
| D0330 |
Panoramic radiographic image |
281 |
272 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
132 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
74 |
$6K |
| D4341 |
|
35 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
339 |
323 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
198 |
$3K |
| D2330 |
|
35 |
24 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$706.50 |
| D0270 |
|
62 |
62 |
$336.00 |
| D1999 |
|
546 |
331 |
$0.00 |