| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,965 |
5,832 |
$248K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,114 |
816 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
6,528 |
6,358 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,816 |
676 |
$144K |
| D4341 |
|
850 |
414 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,086 |
1,748 |
$140K |
| D1351 |
Sealant - per tooth |
1,528 |
797 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,853 |
3,742 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,297 |
4,137 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,752 |
1,458 |
$80K |
| D1110 |
Prophylaxis - adult |
1,787 |
1,740 |
$80K |
| D0274 |
Bitewings - four radiographic images |
4,385 |
4,235 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
623 |
546 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
2,512 |
2,432 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
7,023 |
6,694 |
$42K |
| D0330 |
Panoramic radiographic image |
1,834 |
1,807 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,312 |
4,962 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
1,020 |
955 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,758 |
1,697 |
$17K |
| D9110 |
|
117 |
110 |
$6K |
| D2330 |
|
90 |
79 |
$6K |
| D2335 |
|
45 |
44 |
$5K |
| D0270 |
|
297 |
289 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D1354 |
|
27 |
26 |
$950.40 |