| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,265 |
1,098 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,454 |
1,207 |
$35K |
| D4341 |
|
236 |
102 |
$35K |
| D1351 |
Sealant - per tooth |
471 |
211 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,223 |
1,060 |
$27K |
| D4342 |
|
244 |
94 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,061 |
923 |
$15K |
| D1110 |
Prophylaxis - adult |
391 |
355 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
597 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
147 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,853 |
1,509 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
175 |
113 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,682 |
1,377 |
$6K |
| D2330 |
|
105 |
52 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
58 |
$4K |
| D0272 |
Bitewings - two radiographic images |
412 |
333 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
42 |
$3K |
| D2332 |
|
34 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
178 |
$3K |
| D0330 |
Panoramic radiographic image |
142 |
129 |
$2K |
| D2331 |
|
37 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
15 |
$233.40 |