| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,226 |
1,105 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,165 |
1,060 |
$29K |
| D1206 |
Topical application of fluoride varnish |
889 |
771 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
151 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
425 |
407 |
$11K |
| D0274 |
Bitewings - four radiographic images |
514 |
469 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
401 |
374 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
136 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
119 |
$6K |
| D1110 |
Prophylaxis - adult |
139 |
137 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
195 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
451 |
$3K |
| D1351 |
Sealant - per tooth |
42 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
210 |
189 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
157 |
$1K |
| D1999 |
|
146 |
117 |
$0.00 |