| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,143 |
1,719 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,483 |
1,982 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,139 |
1,717 |
$49K |
| D1351 |
Sealant - per tooth |
549 |
227 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
526 |
326 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,453 |
1,199 |
$21K |
| D1110 |
Prophylaxis - adult |
518 |
440 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
650 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,255 |
1,610 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,206 |
1,778 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
175 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
98 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
283 |
$5K |
| D0272 |
Bitewings - two radiographic images |
399 |
316 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
215 |
192 |
$2K |
| D1999 |
|
949 |
851 |
$0.00 |