| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,467 |
10,234 |
$430K |
| D1351 |
Sealant - per tooth |
6,141 |
2,843 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
10,530 |
10,289 |
$293K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,047 |
9,814 |
$261K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,795 |
1,201 |
$122K |
| D0274 |
Bitewings - four radiographic images |
4,880 |
4,762 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
11,415 |
11,108 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
939 |
739 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,377 |
2,331 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,292 |
9,915 |
$47K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,046 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
715 |
539 |
$39K |
| D2140 |
|
830 |
622 |
$31K |
| D8670 |
Periodic orthodontic treatment visit |
127 |
127 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,619 |
1,582 |
$29K |
| D4341 |
|
155 |
102 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,177 |
2,121 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
171 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
324 |
$18K |
| D0270 |
|
2,914 |
2,905 |
$16K |
| D2160 |
|
122 |
95 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
65 |
$6K |
| D1206 |
Topical application of fluoride varnish |
191 |
191 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
64 |
$752.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$331.31 |