| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,026 |
4,472 |
$204K |
| D1351 |
Sealant - per tooth |
3,792 |
1,270 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
5,445 |
4,900 |
$150K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,588 |
4,077 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,158 |
620 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,902 |
2,341 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,109 |
1,708 |
$46K |
| D1110 |
Prophylaxis - adult |
1,023 |
861 |
$42K |
| D4341 |
|
253 |
97 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
5,157 |
4,278 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,656 |
1,328 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
501 |
355 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,834 |
3,588 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
246 |
152 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
504 |
500 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
352 |
263 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,051 |
878 |
$10K |
| D1206 |
Topical application of fluoride varnish |
309 |
295 |
$8K |
| D1999 |
|
1,534 |
1,397 |
$0.00 |