| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,426 |
3,091 |
$124K |
| D4341 |
|
793 |
341 |
$123K |
| D1351 |
Sealant - per tooth |
1,942 |
763 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,562 |
3,166 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,224 |
2,926 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,272 |
722 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,553 |
2,239 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,032 |
490 |
$44K |
| D1110 |
Prophylaxis - adult |
1,308 |
1,156 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,799 |
2,430 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
546 |
367 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,476 |
3,933 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,419 |
3,475 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
811 |
754 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
32 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
88 |
$7K |
| D0272 |
Bitewings - two radiographic images |
748 |
687 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
450 |
395 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
86 |
$6K |
| D1206 |
Topical application of fluoride varnish |
175 |
146 |
$4K |
| D9110 |
|
93 |
81 |
$4K |
| D2950 |
|
57 |
43 |
$3K |
| D1999 |
|
432 |
379 |
$0.00 |