| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,174 |
2,127 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,807 |
2,654 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
645 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
855 |
592 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,484 |
1,444 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
626 |
402 |
$33K |
| D1110 |
Prophylaxis - adult |
733 |
689 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,624 |
1,519 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,119 |
2,912 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
784 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,560 |
2,411 |
$12K |
| D2330 |
|
286 |
157 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
476 |
455 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
574 |
$9K |
| D2331 |
|
166 |
108 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
108 |
$7K |
| D9110 |
|
212 |
186 |
$7K |
| D2332 |
|
81 |
48 |
$4K |
| D1206 |
Topical application of fluoride varnish |
135 |
135 |
$4K |
| D0272 |
Bitewings - two radiographic images |
317 |
304 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
24 |
$2K |
| D0270 |
|
189 |
183 |
$1K |
| D2940 |
|
15 |
13 |
$180.80 |
| D1999 |
|
673 |
469 |
$0.00 |