| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,249 |
5,863 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
6,653 |
6,232 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,817 |
1,142 |
$152K |
| D1206 |
Topical application of fluoride varnish |
5,830 |
5,461 |
$144K |
| D1351 |
Sealant - per tooth |
1,513 |
790 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,282 |
3,066 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
6,453 |
6,017 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,518 |
1,454 |
$32K |
| D1110 |
Prophylaxis - adult |
728 |
696 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,976 |
5,533 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,599 |
2,443 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
192 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
318 |
238 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
52 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
255 |
247 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
54 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
165 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
81 |
$2K |
| D0270 |
|
237 |
223 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$1K |
| D1999 |
|
469 |
343 |
$0.00 |