| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
781 |
767 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
892 |
870 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
778 |
764 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
133 |
$10K |
| D0274 |
Bitewings - four radiographic images |
564 |
546 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
138 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
287 |
$6K |
| D1110 |
Prophylaxis - adult |
207 |
197 |
$6K |
| D1351 |
Sealant - per tooth |
109 |
47 |
$5K |
| D4342 |
|
68 |
26 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
97 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
510 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
148 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
330 |
313 |
$2K |
| D0272 |
Bitewings - two radiographic images |
174 |
172 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$304.90 |