| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,430 |
1,306 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,679 |
1,490 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
548 |
304 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,230 |
1,123 |
$30K |
| D1110 |
Prophylaxis - adult |
707 |
657 |
$26K |
| D1351 |
Sealant - per tooth |
347 |
150 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
280 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
798 |
742 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,022 |
931 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
373 |
261 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,129 |
1,896 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,832 |
1,628 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
457 |
415 |
$7K |
| D0272 |
Bitewings - two radiographic images |
617 |
552 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
54 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
117 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
57 |
$1K |
| D2331 |
|
20 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D1999 |
|
471 |
423 |
$0.00 |