| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,548 |
5,516 |
$231K |
| D1351 |
Sealant - per tooth |
2,430 |
1,390 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,292 |
5,263 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,165 |
4,158 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,070 |
4,958 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,501 |
1,474 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
5,441 |
5,375 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,310 |
1,303 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
298 |
226 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
195 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,476 |
1,465 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
379 |
365 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
177 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
413 |
$8K |
| D1206 |
Topical application of fluoride varnish |
267 |
267 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
26 |
$2K |
| D0270 |
|
102 |
99 |
$567.50 |