| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,249 |
1,215 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
807 |
321 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,519 |
1,429 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
584 |
287 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,535 |
1,461 |
$32K |
| D1206 |
Topical application of fluoride varnish |
843 |
829 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
840 |
800 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
907 |
892 |
$15K |
| D1110 |
Prophylaxis - adult |
404 |
387 |
$15K |
| D4341 |
|
81 |
39 |
$9K |
| D0330 |
Panoramic radiographic image |
480 |
431 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
91 |
$8K |
| D0274 |
Bitewings - four radiographic images |
441 |
426 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
908 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
181 |
$5K |
| D5110 |
|
13 |
13 |
$5K |
| D5120 |
|
12 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
454 |
416 |
$4K |
| D1351 |
Sealant - per tooth |
26 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
76 |
61 |
$256.50 |