| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,547 |
7,547 |
$376K |
| D1120 |
Prophylaxis - child |
8,103 |
8,103 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
11,692 |
11,692 |
$266K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,064 |
1,614 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,756 |
1,568 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,516 |
12,516 |
$204K |
| D0274 |
Bitewings - four radiographic images |
7,477 |
7,477 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,376 |
4,376 |
$171K |
| D1351 |
Sealant - per tooth |
5,291 |
1,475 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
3,632 |
3,611 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,547 |
931 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
8,791 |
8,687 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,196 |
5,555 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
464 |
464 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
92 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
98 |
$15K |
| D0272 |
Bitewings - two radiographic images |
571 |
571 |
$11K |
| D1206 |
Topical application of fluoride varnish |
440 |
440 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
28 |
$4K |
| D2335 |
|
24 |
12 |
$3K |
| D2140 |
|
26 |
12 |
$1K |
| D7111 |
|
13 |
12 |
$865.80 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$432.00 |