| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,350 |
1,344 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
533 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,690 |
1,681 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,275 |
1,268 |
$34K |
| D1351 |
Sealant - per tooth |
353 |
268 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,021 |
1,015 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
160 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
550 |
$14K |
| D1110 |
Prophylaxis - adult |
271 |
271 |
$13K |
| D0330 |
Panoramic radiographic image |
415 |
413 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
39 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
784 |
775 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
57 |
$5K |
| D9110 |
|
74 |
73 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
484 |
481 |
$4K |
| D0272 |
Bitewings - two radiographic images |
327 |
327 |
$3K |
| D4342 |
|
16 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$707.44 |