| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,456 |
3,968 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,628 |
4,976 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,491 |
1,440 |
$144K |
| D1351 |
Sealant - per tooth |
1,573 |
875 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,335 |
3,854 |
$107K |
| D1110 |
Prophylaxis - adult |
1,689 |
1,496 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,229 |
2,895 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,870 |
1,668 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,929 |
1,699 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
4,494 |
3,983 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
176 |
$15K |
| D5110 |
|
41 |
40 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,074 |
1,697 |
$15K |
| D5120 |
|
26 |
26 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
108 |
$9K |
| D0272 |
Bitewings - two radiographic images |
953 |
852 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
394 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
28 |
$8K |
| D1999 |
|
1,169 |
961 |
$0.00 |