| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
622 |
574 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
210 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
316 |
$18K |
| D0274 |
Bitewings - four radiographic images |
842 |
780 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
444 |
406 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
155 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
459 |
423 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
322 |
138 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,719 |
945 |
$12K |
| D1351 |
Sealant - per tooth |
526 |
89 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
904 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
542 |
474 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
117 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
494 |
$5K |
| D1206 |
Topical application of fluoride varnish |
58 |
57 |
$2K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$460.00 |
| D0602 |
|
15 |
15 |
$75.00 |