| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,278 |
1,225 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,524 |
1,442 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,265 |
1,212 |
$29K |
| D1110 |
Prophylaxis - adult |
508 |
477 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
207 |
$16K |
| D0274 |
Bitewings - four radiographic images |
888 |
839 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
180 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
558 |
531 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
866 |
$5K |
| D4341 |
|
24 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
842 |
627 |
$4K |
| D1351 |
Sealant - per tooth |
88 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
81 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
175 |
167 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
161 |
158 |
$2K |
| D0272 |
Bitewings - two radiographic images |
247 |
239 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
13 |
$914.85 |
| D1999 |
|
440 |
365 |
$0.00 |