| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,645 |
5,481 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,893 |
2,295 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
6,810 |
6,606 |
$188K |
| D2740 |
Crown - porcelain/ceramic |
314 |
246 |
$113K |
| D1110 |
Prophylaxis - adult |
2,339 |
2,310 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,895 |
1,552 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,936 |
2,849 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
896 |
756 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,351 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,434 |
2,356 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
1,013 |
$32K |
| D4341 |
|
105 |
55 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,181 |
1,128 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
332 |
281 |
$20K |
| D1351 |
Sealant - per tooth |
152 |
95 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,099 |
1,068 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,665 |
1,547 |
$10K |
| D2950 |
|
103 |
92 |
$8K |
| D2331 |
|
84 |
64 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
42 |
$4K |
| D0330 |
Panoramic radiographic image |
102 |
102 |
$3K |
| D2332 |
|
23 |
18 |
$2K |
| D1206 |
Topical application of fluoride varnish |
66 |
66 |
$2K |
| D2330 |
|
34 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
201 |
180 |
$1K |