| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,217 |
2,120 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,054 |
2,879 |
$84K |
| D1206 |
Topical application of fluoride varnish |
1,950 |
1,868 |
$50K |
| D1351 |
Sealant - per tooth |
566 |
281 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
591 |
491 |
$40K |
| D1110 |
Prophylaxis - adult |
792 |
774 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
718 |
585 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,339 |
1,253 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,517 |
4,169 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,361 |
1,304 |
$24K |
| D4341 |
|
108 |
58 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
842 |
759 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,106 |
3,790 |
$16K |
| D0330 |
Panoramic radiographic image |
387 |
363 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
271 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
34 |
$4K |
| D0272 |
Bitewings - two radiographic images |
269 |
257 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| D4910 |
|
12 |
12 |
$804.00 |