| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,726 |
1,580 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,375 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,546 |
1,411 |
$39K |
| D1351 |
Sealant - per tooth |
418 |
217 |
$29K |
| D0274 |
Bitewings - four radiographic images |
661 |
599 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,609 |
1,466 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
271 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,417 |
1,290 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
43 |
$3K |
| D0272 |
Bitewings - two radiographic images |
331 |
300 |
$3K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$904.20 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
39 |
$648.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$547.68 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$451.60 |
| D0270 |
|
31 |
29 |
$173.60 |