| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,219 |
2,128 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,252 |
3,108 |
$87K |
| D1110 |
Prophylaxis - adult |
1,273 |
1,205 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,062 |
1,014 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,190 |
1,133 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
181 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
391 |
$9K |
| D1351 |
Sealant - per tooth |
42 |
30 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
79 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
124 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
175 |
172 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
324 |
321 |
$2K |
| D0272 |
Bitewings - two radiographic images |
145 |
139 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
16 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$803.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
118 |
$524.16 |
| D1999 |
|
14 |
14 |
$0.00 |