| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,974 |
4,965 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
7,876 |
7,855 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,296 |
1,396 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,620 |
5,600 |
$110K |
| D1110 |
Prophylaxis - adult |
3,374 |
3,357 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,694 |
977 |
$65K |
| D1351 |
Sealant - per tooth |
3,929 |
619 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,702 |
1,674 |
$54K |
| D0274 |
Bitewings - four radiographic images |
5,212 |
5,199 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,209 |
1,206 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
826 |
450 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,537 |
5,465 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
978 |
970 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,190 |
4,174 |
$11K |
| D2750 |
|
25 |
24 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
460 |
453 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,101 |
1,100 |
$10K |
| D0330 |
Panoramic radiographic image |
303 |
303 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
88 |
$6K |
| D0601 |
|
135 |
131 |
$1K |
| D1999 |
|
352 |
330 |
$0.00 |