| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
3,288 |
2,954 |
$198K |
| D1110 |
Prophylaxis - adult |
3,581 |
3,373 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,154 |
2,944 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,171 |
522 |
$74K |
| D1120 |
Prophylaxis - child |
1,464 |
1,452 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,705 |
1,681 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,685 |
2,570 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,318 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
726 |
650 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
189 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
986 |
885 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
51 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
120 |
$4K |
| X4345 |
|
49 |
43 |
$3K |
| D1351 |
Sealant - per tooth |
87 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
108 |
107 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$707.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$160.46 |
| D0603 |
|
974 |
886 |
$0.00 |