| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,281 |
3,212 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,521 |
4,449 |
$73K |
| D1120 |
Prophylaxis - child |
2,305 |
2,280 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,524 |
3,489 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
996 |
295 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,071 |
2,035 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
909 |
495 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
838 |
442 |
$34K |
| D0330 |
Panoramic radiographic image |
686 |
548 |
$24K |
| D9630 |
|
1,272 |
1,259 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
994 |
784 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
857 |
643 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,229 |
1,132 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
619 |
562 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$503.75 |
| D1351 |
Sealant - per tooth |
141 |
38 |
$0.00 |
| D2331 |
|
17 |
12 |
$0.00 |