| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,012 |
3,781 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
4,799 |
4,535 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,772 |
1,213 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,420 |
3,290 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
949 |
496 |
$78K |
| D1351 |
Sealant - per tooth |
1,217 |
471 |
$71K |
| D0274 |
Bitewings - four radiographic images |
4,301 |
4,134 |
$68K |
| D1110 |
Prophylaxis - adult |
1,403 |
1,365 |
$64K |
| D4341 |
|
336 |
160 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,380 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
632 |
468 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
6,424 |
6,119 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
630 |
415 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,260 |
5,594 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
737 |
555 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
90 |
77 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
799 |
$15K |
| D4342 |
|
93 |
50 |
$13K |
| D1206 |
Topical application of fluoride varnish |
456 |
371 |
$12K |
| D0330 |
Panoramic radiographic image |
530 |
518 |
$11K |
| D0603 |
|
52 |
52 |
$8K |
| D0602 |
|
60 |
60 |
$7K |
| D0272 |
Bitewings - two radiographic images |
450 |
429 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
249 |
$4K |
| D4910 |
|
24 |
24 |
$2K |
| D0601 |
|
12 |
12 |
$1K |
| D2331 |
|
15 |
13 |
$1K |
| D1999 |
|
495 |
441 |
$0.00 |