| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,450 |
2,370 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,511 |
2,354 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
917 |
563 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
682 |
479 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
749 |
569 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,196 |
2,108 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,802 |
2,636 |
$43K |
| D1351 |
Sealant - per tooth |
596 |
221 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,401 |
1,363 |
$35K |
| D1110 |
Prophylaxis - adult |
844 |
833 |
$35K |
| D4341 |
|
273 |
131 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,933 |
4,614 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
985 |
950 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,541 |
4,247 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
334 |
269 |
$13K |
| D4342 |
|
225 |
97 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
701 |
674 |
$11K |
| D0330 |
Panoramic radiographic image |
666 |
652 |
$10K |
| D0272 |
Bitewings - two radiographic images |
911 |
871 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
420 |
$7K |
| D5110 |
|
14 |
14 |
$6K |
| D2331 |
|
17 |
16 |
$1K |
| D1999 |
|
375 |
326 |
$0.00 |