| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,491 |
5,131 |
$212K |
| D1351 |
Sealant - per tooth |
2,875 |
1,574 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
5,281 |
4,912 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,267 |
4,924 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
1,284 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,286 |
801 |
$75K |
| D1110 |
Prophylaxis - adult |
1,911 |
1,764 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,491 |
1,190 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,829 |
2,614 |
$56K |
| D0274 |
Bitewings - four radiographic images |
3,081 |
2,865 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
532 |
344 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
6,944 |
6,397 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,169 |
5,636 |
$25K |
| D5110 |
|
59 |
55 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,265 |
2,096 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
215 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
776 |
$13K |
| D0330 |
Panoramic radiographic image |
604 |
561 |
$12K |
| D5120 |
|
14 |
13 |
$5K |
| D2330 |
|
87 |
72 |
$3K |
| D2331 |
|
35 |
31 |
$2K |
| D2332 |
|
16 |
15 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
112 |
$820.48 |
| D0270 |
|
142 |
127 |
$770.07 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
26 |
$638.85 |
| D1999 |
|
1,600 |
1,351 |
$0.00 |