| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,987 |
7,551 |
$324K |
| D0120 |
Periodic oral evaluation - established patient |
8,430 |
7,883 |
$230K |
| D1351 |
Sealant - per tooth |
2,783 |
1,264 |
$196K |
| D1206 |
Topical application of fluoride varnish |
6,885 |
6,509 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,447 |
1,882 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,205 |
5,518 |
$132K |
| D1110 |
Prophylaxis - adult |
3,425 |
3,211 |
$132K |
| D4341 |
|
523 |
323 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,170 |
1,594 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,168 |
905 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
14,325 |
12,922 |
$80K |
| D0274 |
Bitewings - four radiographic images |
4,615 |
4,300 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
4,090 |
3,375 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,693 |
11,420 |
$51K |
| D0330 |
Panoramic radiographic image |
2,452 |
2,317 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,460 |
1,348 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
307 |
238 |
$22K |
| D9110 |
|
391 |
370 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,616 |
1,554 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
127 |
$7K |
| D2330 |
|
146 |
112 |
$7K |
| D2332 |
|
85 |
71 |
$6K |
| D4910 |
|
70 |
70 |
$4K |
| D4342 |
|
21 |
14 |
$2K |
| D2331 |
|
30 |
26 |
$2K |
| D2335 |
|
14 |
12 |
$1K |
| D2950 |
|
14 |
12 |
$696.60 |
| D0270 |
|
36 |
36 |
$201.60 |