| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,074 |
2,847 |
$122K |
| D1351 |
Sealant - per tooth |
1,702 |
795 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,699 |
1,093 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,342 |
3,057 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,375 |
1,024 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,833 |
2,641 |
$72K |
| D4341 |
|
342 |
229 |
$59K |
| D1110 |
Prophylaxis - adult |
1,398 |
1,319 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,282 |
2,142 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,615 |
1,529 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
578 |
486 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,918 |
1,776 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
671 |
525 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,537 |
3,212 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,016 |
938 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,778 |
2,471 |
$11K |
| D2335 |
|
30 |
29 |
$3K |
| D2331 |
|
35 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
272 |
242 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
17 |
$1K |
| D0270 |
|
12 |
12 |
$61.60 |