| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
871 |
826 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
965 |
909 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
795 |
755 |
$20K |
| D1110 |
Prophylaxis - adult |
384 |
357 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
166 |
$12K |
| D0274 |
Bitewings - four radiographic images |
521 |
489 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
371 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
424 |
385 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
999 |
928 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
100 |
$5K |
| D1351 |
Sealant - per tooth |
59 |
25 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
42 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
818 |
746 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
93 |
$2K |
| D0270 |
|
152 |
137 |
$823.20 |
| D0272 |
Bitewings - two radiographic images |
44 |
41 |
$394.80 |