| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,608 |
1,542 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,285 |
2,192 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,281 |
1,234 |
$33K |
| D1110 |
Prophylaxis - adult |
617 |
603 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
321 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,139 |
1,092 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,163 |
2,960 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
782 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,463 |
2,335 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
481 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
113 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
161 |
157 |
$5K |
| D1351 |
Sealant - per tooth |
44 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
151 |
151 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
98 |
95 |
$896.17 |
| D0270 |
|
99 |
98 |
$548.80 |