| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,164 |
10,034 |
$450K |
| D1351 |
Sealant - per tooth |
7,542 |
2,239 |
$418K |
| D0120 |
Periodic oral evaluation - established patient |
13,463 |
12,099 |
$370K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,158 |
10,034 |
$285K |
| D4341 |
|
1,699 |
836 |
$262K |
| D0274 |
Bitewings - four radiographic images |
6,585 |
5,922 |
$114K |
| D1110 |
Prophylaxis - adult |
2,425 |
2,186 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,301 |
2,924 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,070 |
679 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
8,518 |
7,658 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
366 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,258 |
6,561 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
577 |
375 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,154 |
1,917 |
$20K |
| D2332 |
|
125 |
67 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
670 |
634 |
$11K |
| D4342 |
|
90 |
41 |
$10K |
| D9110 |
|
142 |
129 |
$7K |
| D2950 |
|
116 |
80 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
112 |
70 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
48 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
221 |
211 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
25 |
$2K |
| D1999 |
|
3,985 |
3,658 |
$0.00 |