| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
528 |
472 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
525 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
517 |
460 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
123 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
120 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
499 |
473 |
$10K |
| D1110 |
Prophylaxis - adult |
210 |
198 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
287 |
275 |
$8K |
| D0274 |
Bitewings - four radiographic images |
356 |
323 |
$6K |
| D4341 |
|
29 |
15 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
64 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
551 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
65 |
$3K |
| D1351 |
Sealant - per tooth |
38 |
20 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
152 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
502 |
453 |
$2K |
| D0272 |
Bitewings - two radiographic images |
93 |
80 |
$855.40 |