| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,409 |
5,104 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
6,910 |
6,436 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,481 |
4,316 |
$113K |
| D1351 |
Sealant - per tooth |
1,461 |
626 |
$86K |
| D1110 |
Prophylaxis - adult |
1,746 |
1,649 |
$74K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
281 |
227 |
$72K |
| D0274 |
Bitewings - four radiographic images |
4,120 |
3,858 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,076 |
1,960 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
6,308 |
5,904 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
518 |
357 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,044 |
5,035 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
342 |
$25K |
| D4341 |
|
138 |
68 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
1,210 |
$21K |
| D1206 |
Topical application of fluoride varnish |
768 |
640 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
470 |
$10K |
| D0272 |
Bitewings - two radiographic images |
858 |
806 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
53 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
34 |
$2K |
| D0270 |
|
18 |
14 |
$87.80 |
| D1999 |
|
1,139 |
1,041 |
$0.00 |