| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,140 |
7,739 |
$325K |
| D0120 |
Periodic oral evaluation - established patient |
8,567 |
8,123 |
$234K |
| D1206 |
Topical application of fluoride varnish |
7,958 |
7,589 |
$202K |
| D1351 |
Sealant - per tooth |
2,135 |
1,194 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
1,074 |
$102K |
| D0274 |
Bitewings - four radiographic images |
5,017 |
4,795 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
9,691 |
9,147 |
$57K |
| D1110 |
Prophylaxis - adult |
1,190 |
1,158 |
$52K |
| D4341 |
|
218 |
110 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,893 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,303 |
8,799 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,931 |
2,757 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
515 |
408 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
251 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
29 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
166 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
48 |
$1K |
| D0270 |
|
70 |
51 |
$302.40 |
| D1999 |
|
615 |
474 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |