| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,471 |
2,470 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,270 |
3,270 |
$89K |
| D1351 |
Sealant - per tooth |
2,245 |
594 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
457 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,377 |
3,376 |
$48K |
| D1110 |
Prophylaxis - adult |
1,014 |
1,014 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,817 |
1,816 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,262 |
1,262 |
$21K |
| D0274 |
Bitewings - four radiographic images |
659 |
659 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
221 |
$17K |
| D0330 |
Panoramic radiographic image |
235 |
235 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
542 |
539 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
80 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
105 |
$3K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$2K |
| D9986 |
|
33 |
32 |
$0.00 |