| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,870 |
3,179 |
$156K |
| D4341 |
|
956 |
407 |
$153K |
| D1351 |
Sealant - per tooth |
2,196 |
984 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,909 |
3,978 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,126 |
2,610 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,238 |
652 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
683 |
448 |
$42K |
| D1110 |
Prophylaxis - adult |
882 |
714 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,045 |
1,670 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,331 |
1,083 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
894 |
722 |
$23K |
| D1206 |
Topical application of fluoride varnish |
678 |
525 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,756 |
2,182 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
188 |
112 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
187 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
498 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,135 |
1,561 |
$8K |
| D0272 |
Bitewings - two radiographic images |
776 |
631 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
54 |
$7K |
| D4910 |
|
101 |
82 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$2K |
| D0270 |
|
154 |
125 |
$817.60 |
| D1999 |
|
2,671 |
2,343 |
$14.45 |