| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,409 |
1,300 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,560 |
1,425 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,394 |
1,284 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
283 |
180 |
$13K |
| D1110 |
Prophylaxis - adult |
333 |
296 |
$12K |
| D0274 |
Bitewings - four radiographic images |
782 |
688 |
$12K |
| D1351 |
Sealant - per tooth |
247 |
109 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
378 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
90 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,211 |
1,058 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,276 |
888 |
$5K |
| D0272 |
Bitewings - two radiographic images |
334 |
307 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
130 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
15 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
47 |
$112.30 |
| D1999 |
|
382 |
330 |
$0.00 |