| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,123 |
2,942 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,351 |
3,162 |
$87K |
| D1351 |
Sealant - per tooth |
1,332 |
673 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,120 |
2,941 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,165 |
575 |
$62K |
| D1110 |
Prophylaxis - adult |
1,616 |
1,512 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,947 |
1,829 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
604 |
476 |
$35K |
| D0274 |
Bitewings - four radiographic images |
2,092 |
1,966 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
774 |
518 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
393 |
297 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,329 |
4,062 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,911 |
3,541 |
$16K |
| D0330 |
Panoramic radiographic image |
736 |
686 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,156 |
1,092 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
416 |
$7K |
| D5110 |
|
12 |
12 |
$4K |
| D5120 |
|
12 |
12 |
$4K |
| D2330 |
|
40 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
93 |
$783.77 |
| D0270 |
|
55 |
55 |
$308.00 |