| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,165 |
4,879 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,416 |
5,115 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,534 |
1,189 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,455 |
1,175 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,177 |
2,045 |
$57K |
| D1110 |
Prophylaxis - adult |
1,207 |
1,134 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,621 |
1,552 |
$37K |
| D1351 |
Sealant - per tooth |
388 |
251 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
316 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,110 |
1,019 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
39 |
37 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
153 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
334 |
321 |
$11K |
| D0272 |
Bitewings - two radiographic images |
900 |
839 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
396 |
381 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
43 |
$5K |
| D2332 |
|
47 |
32 |
$5K |
| D0330 |
Panoramic radiographic image |
162 |
161 |
$4K |
| D2331 |
|
35 |
29 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
469 |
$3K |
| D2950 |
|
12 |
12 |
$1K |
| D2394 |
|
12 |
12 |
$1K |