| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,077 |
1,994 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,244 |
963 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,030 |
2,930 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,175 |
3,068 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
626 |
459 |
$47K |
| D2752 |
|
180 |
148 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
7,176 |
6,615 |
$42K |
| D4341 |
|
234 |
93 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,664 |
1,590 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,089 |
2,009 |
$35K |
| D1110 |
Prophylaxis - adult |
840 |
816 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
685 |
576 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,218 |
1,176 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,354 |
4,990 |
$24K |
| D2950 |
|
278 |
247 |
$17K |
| D1351 |
Sealant - per tooth |
100 |
49 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
72 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$3K |
| D0272 |
Bitewings - two radiographic images |
165 |
155 |
$2K |
| D0330 |
Panoramic radiographic image |
75 |
69 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
97 |
$947.90 |
| D9110 |
|
13 |
12 |
$495.00 |
| D0270 |
|
31 |
31 |
$173.60 |