| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,919 |
1,875 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,569 |
2,508 |
$72K |
| D1351 |
Sealant - per tooth |
1,416 |
394 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,900 |
1,854 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
713 |
448 |
$44K |
| D1110 |
Prophylaxis - adult |
793 |
775 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,192 |
2,132 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,018 |
977 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,187 |
3,088 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,620 |
2,837 |
$17K |
| D4341 |
|
111 |
41 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
83 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
104 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
277 |
269 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
95 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
117 |
$3K |
| D0272 |
Bitewings - two radiographic images |
291 |
286 |
$2K |
| D0330 |
Panoramic radiographic image |
88 |
86 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
15 |
$1K |