| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,430 |
4,415 |
$186K |
| D1351 |
Sealant - per tooth |
3,222 |
1,803 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
4,170 |
4,160 |
$120K |
| D1206 |
Topical application of fluoride varnish |
3,947 |
3,947 |
$106K |
| D1354 |
|
985 |
528 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
124 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
426 |
413 |
$11K |
| D0274 |
Bitewings - four radiographic images |
587 |
564 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
461 |
430 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
109 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
100 |
$6K |
| D1110 |
Prophylaxis - adult |
147 |
145 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
561 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
628 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
67 |
$1K |
| D0272 |
Bitewings - two radiographic images |
111 |
110 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
107 |
$778.00 |
| D1999 |
|
22 |
19 |
$0.00 |
| D0602 |
|
824 |
824 |
$0.00 |
| D0601 |
|
947 |
947 |
$0.00 |
| D0603 |
|
856 |
856 |
$0.00 |