| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,320 |
1,279 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,358 |
1,309 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,801 |
2,642 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
778 |
724 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
133 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,833 |
1,737 |
$12K |
| D0272 |
Bitewings - two radiographic images |
934 |
904 |
$12K |
| D1206 |
Topical application of fluoride varnish |
852 |
830 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
250 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
463 |
445 |
$5K |
| D1999 |
|
1,004 |
902 |
$4K |
| D0274 |
Bitewings - four radiographic images |
208 |
206 |
$4K |
| D1110 |
Prophylaxis - adult |
109 |
103 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
15 |
$1K |
| D1351 |
Sealant - per tooth |
59 |
13 |
$428.78 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$365.58 |
| D0603 |
|
392 |
379 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$0.00 |