| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,087 |
10,775 |
$451K |
| D0120 |
Periodic oral evaluation - established patient |
12,362 |
11,984 |
$342K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,553 |
10,249 |
$272K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,770 |
1,885 |
$221K |
| D1351 |
Sealant - per tooth |
3,853 |
1,596 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,414 |
2,288 |
$202K |
| D1110 |
Prophylaxis - adult |
2,212 |
2,139 |
$88K |
| D4341 |
|
549 |
270 |
$82K |
| D0274 |
Bitewings - four radiographic images |
4,631 |
4,472 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,137 |
3,024 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,775 |
1,306 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
11,067 |
10,582 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
3,008 |
2,860 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,653 |
1,608 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,317 |
8,600 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
583 |
423 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,401 |
2,326 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
252 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
73 |
$2K |
| D9110 |
|
28 |
25 |
$1K |