| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,866 |
2,724 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,229 |
3,038 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,863 |
2,714 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
556 |
365 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,813 |
1,694 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,305 |
3,077 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
877 |
828 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,386 |
2,891 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
585 |
553 |
$15K |
| D1110 |
Prophylaxis - adult |
295 |
270 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
180 |
$10K |
| D0272 |
Bitewings - two radiographic images |
481 |
457 |
$4K |
| D4342 |
|
26 |
13 |
$4K |
| D1351 |
Sealant - per tooth |
60 |
26 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
67 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$938.88 |
| D4910 |
|
13 |
13 |
$871.00 |
| D1999 |
|
15 |
15 |
$0.00 |