| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,667 |
3,751 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
3,246 |
2,997 |
$84K |
| D1206 |
Topical application of fluoride varnish |
4,197 |
3,308 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,491 |
1,129 |
$73K |
| D1351 |
Sealant - per tooth |
2,410 |
352 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
955 |
414 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,529 |
1,226 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,041 |
1,598 |
$47K |
| D0330 |
Panoramic radiographic image |
746 |
666 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,549 |
844 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
344 |
188 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
412 |
147 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,015 |
847 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
27 |
$569.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
15 |
$250.23 |
| D1999 |
|
1,759 |
1,621 |
$0.00 |