| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,341 |
4,986 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,315 |
4,996 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,739 |
4,434 |
$120K |
| D1351 |
Sealant - per tooth |
1,754 |
976 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
943 |
651 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
6,496 |
5,974 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,433 |
1,317 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,338 |
1,264 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,906 |
5,466 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,413 |
2,208 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
486 |
355 |
$20K |
| D4341 |
|
75 |
41 |
$14K |
| D9110 |
|
251 |
234 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
660 |
607 |
$11K |
| D0270 |
|
1,657 |
1,566 |
$9K |
| D1110 |
Prophylaxis - adult |
163 |
155 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
60 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
65 |
$5K |
| D0330 |
Panoramic radiographic image |
50 |
49 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$880.49 |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
47 |
$326.60 |