| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,374 |
3,338 |
$141K |
| D1351 |
Sealant - per tooth |
1,976 |
843 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,767 |
3,736 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,336 |
805 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,335 |
3,299 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
559 |
382 |
$60K |
| D0274 |
Bitewings - four radiographic images |
3,508 |
3,474 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,218 |
2,168 |
$52K |
| D4341 |
|
333 |
145 |
$52K |
| D1110 |
Prophylaxis - adult |
926 |
921 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,521 |
5,425 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,716 |
5,016 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
308 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
204 |
158 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
105 |
$11K |
| D0603 |
|
87 |
85 |
$11K |
| D0602 |
|
77 |
76 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
323 |
307 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
130 |
78 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
338 |
$6K |
| D4342 |
|
48 |
24 |
$6K |
| D2332 |
|
34 |
28 |
$4K |
| D0272 |
Bitewings - two radiographic images |
303 |
303 |
$3K |
| D0330 |
Panoramic radiographic image |
119 |
118 |
$2K |
| D2331 |
|
15 |
14 |
$1K |
| D2950 |
|
20 |
13 |
$1K |
| D2140 |
|
25 |
15 |
$832.95 |
| D4910 |
|
13 |
13 |
$804.00 |
| D9110 |
|
14 |
13 |
$770.00 |