| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,449 |
5,330 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
5,964 |
5,838 |
$168K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,246 |
4,147 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
1,379 |
$109K |
| D1110 |
Prophylaxis - adult |
1,411 |
1,380 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,461 |
2,372 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,451 |
2,387 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,537 |
5,338 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
560 |
455 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
594 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,124 |
1,069 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,440 |
4,270 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
246 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,253 |
1,214 |
$22K |
| D1206 |
Topical application of fluoride varnish |
798 |
798 |
$22K |
| D4341 |
|
84 |
55 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
130 |
99 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
1,007 |
$10K |
| D1351 |
Sealant - per tooth |
37 |
26 |
$4K |
| D9110 |
|
15 |
15 |
$825.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
25 |
$728.00 |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$727.00 |