| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,539 |
1,492 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,850 |
1,752 |
$49K |
| D4341 |
|
253 |
142 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,512 |
1,459 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
534 |
389 |
$34K |
| D1110 |
Prophylaxis - adult |
788 |
765 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,221 |
1,179 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
731 |
$21K |
| D0274 |
Bitewings - four radiographic images |
939 |
884 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
182 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
816 |
772 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,667 |
1,567 |
$9K |
| D1351 |
Sealant - per tooth |
39 |
28 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,197 |
1,111 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
28 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
84 |
$723.38 |