| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
875 |
867 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,009 |
997 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
325 |
169 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
262 |
202 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
336 |
$15K |
| D1351 |
Sealant - per tooth |
621 |
110 |
$14K |
| D1120 |
Prophylaxis - child |
403 |
399 |
$12K |
| D0274 |
Bitewings - four radiographic images |
435 |
429 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
508 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
191 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
508 |
504 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
478 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
41 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
29 |
$2K |
| D0272 |
Bitewings - two radiographic images |
104 |
101 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
187 |
166 |
$2K |
| D0270 |
|
128 |
127 |
$1K |
| D1999 |
|
845 |
782 |
$0.00 |