| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,356 |
7,333 |
$321K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,779 |
1,103 |
$221K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,536 |
942 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
6,225 |
6,205 |
$208K |
| D1206 |
Topical application of fluoride varnish |
5,919 |
5,911 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,762 |
826 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,797 |
528 |
$128K |
| D0240 |
|
3,408 |
3,385 |
$90K |
| D0272 |
Bitewings - two radiographic images |
3,100 |
3,091 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,068 |
1,059 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,576 |
1,561 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,351 |
2,292 |
$34K |
| D0330 |
Panoramic radiographic image |
537 |
537 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
766 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,633 |
2,607 |
$24K |
| D1525 |
|
102 |
87 |
$20K |
| D1351 |
Sealant - per tooth |
327 |
87 |
$11K |
| D1527 |
|
26 |
26 |
$6K |
| D2335 |
|
55 |
19 |
$6K |
| D1526 |
|
15 |
15 |
$3K |
| D2394 |
|
21 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
43 |
43 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$2K |