| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,560 |
2,426 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,878 |
2,744 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,997 |
1,880 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
740 |
408 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,992 |
1,902 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
706 |
320 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,432 |
1,358 |
$36K |
| D1351 |
Sealant - per tooth |
465 |
224 |
$34K |
| D4341 |
|
201 |
79 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
84 |
$17K |
| D1110 |
Prophylaxis - adult |
462 |
427 |
$14K |
| D0274 |
Bitewings - four radiographic images |
710 |
678 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,934 |
1,800 |
$11K |
| D2330 |
|
119 |
61 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,336 |
1,257 |
$5K |
| D0272 |
Bitewings - two radiographic images |
304 |
286 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
135 |
$2K |
| D2950 |
|
34 |
26 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
17 |
16 |
$442.00 |