| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,296 |
2,296 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,700 |
2,699 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,118 |
2,118 |
$56K |
| D1110 |
Prophylaxis - adult |
884 |
884 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,999 |
1,998 |
$39K |
| D1351 |
Sealant - per tooth |
482 |
253 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
552 |
480 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,369 |
1,367 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
630 |
533 |
$29K |
| D0330 |
Panoramic radiographic image |
1,097 |
1,096 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
369 |
233 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,061 |
3,049 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
917 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,733 |
2,686 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
303 |
$7K |
| D4342 |
|
38 |
22 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
120 |
120 |
$3K |
| D0272 |
Bitewings - two radiographic images |
127 |
127 |
$1K |