| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,501 |
5,016 |
$216K |
| D0210 |
Intraoral - complete series of radiographic images |
4,345 |
3,696 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,633 |
9,428 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,849 |
4,482 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,968 |
1,581 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
6,364 |
5,801 |
$155K |
| D1110 |
Prophylaxis - adult |
5,263 |
4,493 |
$144K |
| D0274 |
Bitewings - four radiographic images |
4,198 |
3,776 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
3,674 |
3,208 |
$88K |
| D1351 |
Sealant - per tooth |
2,225 |
522 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,260 |
665 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,943 |
5,089 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,480 |
2,586 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
358 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
174 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
119 |
53 |
$7K |
| D8660 |
|
203 |
117 |
$3K |
| D2331 |
|
36 |
24 |
$2K |
| D0270 |
|
374 |
330 |
$2K |
| D9310 |
|
119 |
103 |
$2K |
| D2954 |
|
24 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D2140 |
|
23 |
14 |
$997.88 |
| D0470 |
|
37 |
35 |
$96.00 |
| D0330 |
Panoramic radiographic image |
55 |
51 |
$85.00 |
| D0340 |
|
35 |
34 |
$0.00 |
| D0350 |
|
37 |
35 |
$0.00 |