| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,635 |
5,385 |
$229K |
| D1351 |
Sealant - per tooth |
3,999 |
1,587 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
6,801 |
6,509 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,539 |
5,292 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,645 |
1,175 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,048 |
751 |
$85K |
| D1110 |
Prophylaxis - adult |
1,575 |
1,523 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,960 |
3,797 |
$66K |
| D4341 |
|
306 |
151 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,013 |
1,934 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
6,249 |
5,930 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,635 |
4,899 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,363 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
95 |
$16K |
| D0330 |
Panoramic radiographic image |
659 |
648 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
698 |
655 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
156 |
$8K |
| D0272 |
Bitewings - two radiographic images |
556 |
534 |
$6K |
| D1206 |
Topical application of fluoride varnish |
42 |
41 |
$885.07 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$625.92 |
| D0270 |
|
86 |
85 |
$473.21 |