| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,119 |
4,108 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
2,601 |
2,589 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,696 |
2,685 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,284 |
1,284 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,366 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
441 |
260 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,496 |
1,495 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
859 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
111 |
$13K |
| D0330 |
Panoramic radiographic image |
223 |
223 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
590 |
582 |
$7K |
| D1351 |
Sealant - per tooth |
199 |
68 |
$5K |
| D4346 |
|
37 |
37 |
$5K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$4K |
| D1110 |
Prophylaxis - adult |
83 |
83 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
40 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
150 |
$1K |
| D0240 |
|
61 |
38 |
$848.34 |
| D9985 |
|
123 |
119 |
$0.00 |