| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,111 |
4,774 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
5,720 |
5,373 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,580 |
697 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,937 |
6,468 |
$90K |
| D0330 |
Panoramic radiographic image |
2,797 |
2,562 |
$88K |
| D1110 |
Prophylaxis - adult |
2,034 |
1,908 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,243 |
2,023 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
380 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,595 |
2,400 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,814 |
3,451 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,487 |
3,102 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,099 |
1,003 |
$20K |
| D1351 |
Sealant - per tooth |
623 |
160 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
66 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
130 |
$4K |
| D9110 |
|
15 |
14 |
$588.00 |
| D1330 |
|
7,192 |
6,688 |
$0.00 |