| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,910 |
7,618 |
$324K |
| D0120 |
Periodic oral evaluation - established patient |
8,127 |
7,840 |
$227K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,592 |
7,317 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,248 |
1,714 |
$157K |
| D1351 |
Sealant - per tooth |
1,389 |
779 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,191 |
970 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,091 |
2,003 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
6,155 |
5,861 |
$36K |
| D1110 |
Prophylaxis - adult |
834 |
800 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,316 |
1,241 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,560 |
2,437 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,634 |
5,351 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
510 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
294 |
285 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
38 |
$4K |
| D4341 |
|
18 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
40 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$760.49 |
| D9110 |
|
12 |
12 |
$660.00 |
| D0270 |
|
12 |
12 |
$67.20 |