| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,663 |
3,536 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,036 |
3,885 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,440 |
1,052 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,039 |
2,941 |
$78K |
| D4341 |
|
326 |
199 |
$56K |
| D1351 |
Sealant - per tooth |
856 |
453 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,055 |
763 |
$48K |
| D8670 |
Periodic orthodontic treatment visit |
181 |
174 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,383 |
1,328 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,293 |
5,042 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
312 |
248 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,280 |
1,253 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
242 |
205 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,831 |
4,607 |
$20K |
| D1110 |
Prophylaxis - adult |
383 |
367 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
297 |
232 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,336 |
1,266 |
$13K |
| D9110 |
|
167 |
154 |
$9K |
| D0270 |
|
1,362 |
1,313 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
392 |
$7K |
| D1206 |
Topical application of fluoride varnish |
196 |
186 |
$4K |
| D4910 |
|
38 |
38 |
$2K |
| D2330 |
|
14 |
13 |
$939.24 |
| D8999 |
|
20 |
20 |
$658.70 |