| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,433 |
1,247 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,698 |
$54K |
| D1110 |
Prophylaxis - adult |
1,020 |
901 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,262 |
1,110 |
$32K |
| D1351 |
Sealant - per tooth |
532 |
210 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
506 |
293 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,689 |
1,461 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
282 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
962 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,109 |
1,490 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,121 |
1,816 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
375 |
$7K |
| D4341 |
|
52 |
24 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
44 |
$3K |
| D0272 |
Bitewings - two radiographic images |
295 |
250 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
242 |
$3K |
| D1206 |
Topical application of fluoride varnish |
97 |
77 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
29 |
$1K |
| D0270 |
|
36 |
26 |
$199.70 |
| D1999 |
|
463 |
414 |
$0.00 |