| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,217 |
4,996 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,948 |
5,696 |
$164K |
| D1351 |
Sealant - per tooth |
1,757 |
1,004 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,088 |
3,895 |
$105K |
| D4342 |
|
325 |
185 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
5,906 |
5,500 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,814 |
1,724 |
$32K |
| D4341 |
|
181 |
94 |
$31K |
| D9110 |
|
564 |
550 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,245 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
268 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,953 |
4,638 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,001 |
976 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
253 |
197 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,059 |
1,953 |
$20K |
| D1110 |
Prophylaxis - adult |
376 |
365 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
133 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
78 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
27 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
108 |
$3K |
| D2140 |
|
16 |
12 |
$771.25 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$665.04 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$286.80 |