| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,212 |
1,126 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,936 |
1,771 |
$41K |
| D1110 |
Prophylaxis - adult |
855 |
772 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,155 |
1,052 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
348 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
609 |
425 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,313 |
1,216 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
255 |
$8K |
| D1351 |
Sealant - per tooth |
295 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
515 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
281 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
110 |
108 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
16 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
34 |
$264.84 |
| D9986 |
|
81 |
65 |
$30.00 |