| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,351 |
3,301 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,495 |
3,143 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,674 |
1,191 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,401 |
2,340 |
$128K |
| D0330 |
Panoramic radiographic image |
1,558 |
1,521 |
$105K |
| D1110 |
Prophylaxis - adult |
2,743 |
2,697 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,184 |
3,147 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,739 |
2,691 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,310 |
944 |
$87K |
| D1351 |
Sealant - per tooth |
2,343 |
605 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,516 |
2,478 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,267 |
2,226 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,469 |
3,419 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,005 |
1,975 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
581 |
258 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,601 |
1,572 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
235 |
147 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
76 |
$9K |
| D2140 |
|
77 |
56 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
50 |
$660.96 |