| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,164 |
1,100 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,587 |
1,505 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
378 |
282 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
520 |
289 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
1,086 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
353 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
906 |
771 |
$25K |
| D1351 |
Sealant - per tooth |
324 |
154 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,359 |
1,266 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,346 |
2,085 |
$18K |
| D1110 |
Prophylaxis - adult |
355 |
347 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,514 |
2,286 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
226 |
$11K |
| D0330 |
Panoramic radiographic image |
363 |
351 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
404 |
383 |
$6K |
| D5110 |
|
12 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
187 |
171 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$870.75 |
| D2335 |
|
13 |
12 |
$803.40 |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
48 |
$295.30 |