| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,712 |
6,477 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
7,609 |
7,323 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,662 |
1,689 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,656 |
6,422 |
$172K |
| D1351 |
Sealant - per tooth |
2,884 |
1,016 |
$160K |
| D4342 |
|
812 |
371 |
$107K |
| D0274 |
Bitewings - four radiographic images |
6,291 |
6,097 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,997 |
3,849 |
$91K |
| D4341 |
|
515 |
202 |
$90K |
| D1110 |
Prophylaxis - adult |
2,021 |
1,968 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
924 |
657 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
10,425 |
9,945 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,607 |
9,148 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,333 |
1,233 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,260 |
1,198 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
297 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,186 |
1,145 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
100 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
91 |
$7K |
| D2332 |
|
40 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
253 |
250 |
$4K |
| D4910 |
|
41 |
40 |
$3K |
| D2394 |
|
20 |
18 |
$2K |
| D0601 |
|
45 |
45 |
$2K |
| D2330 |
|
19 |
14 |
$1K |
| D0270 |
|
46 |
42 |
$235.21 |
| D1999 |
|
35 |
35 |
$0.00 |