| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,723 |
10,316 |
$434K |
| D0120 |
Periodic oral evaluation - established patient |
11,098 |
10,689 |
$306K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,587 |
1,882 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,261 |
8,006 |
$215K |
| D1351 |
Sealant - per tooth |
1,648 |
1,138 |
$131K |
| D4341 |
|
383 |
220 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,650 |
3,587 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
589 |
486 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
8,234 |
7,870 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
807 |
658 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,467 |
1,419 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,375 |
1,314 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,280 |
6,964 |
$31K |
| D1110 |
Prophylaxis - adult |
695 |
685 |
$31K |
| D8670 |
Periodic orthodontic treatment visit |
130 |
130 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,742 |
2,587 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,128 |
1,079 |
$20K |
| D0270 |
|
1,264 |
1,183 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
70 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
22 |
$3K |
| D2330 |
|
33 |
24 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D2160 |
|
20 |
13 |
$2K |
| D8999 |
|
58 |
45 |
$2K |
| D2331 |
|
12 |
12 |
$1K |