| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,462 |
7,067 |
$302K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,284 |
2,103 |
$248K |
| D1351 |
Sealant - per tooth |
3,348 |
1,458 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
7,145 |
6,658 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,306 |
6,903 |
$185K |
| D1110 |
Prophylaxis - adult |
3,521 |
3,280 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,003 |
4,723 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
987 |
591 |
$112K |
| D0330 |
Panoramic radiographic image |
1,379 |
1,266 |
$88K |
| D0274 |
Bitewings - four radiographic images |
5,059 |
4,727 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,245 |
762 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,393 |
1,034 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
9,732 |
8,997 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,775 |
7,944 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
732 |
575 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,005 |
1,914 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
841 |
784 |
$18K |
| D4341 |
|
121 |
77 |
$17K |
| D0270 |
|
1,988 |
1,817 |
$11K |
| D2750 |
|
23 |
15 |
$6K |
| D1206 |
Topical application of fluoride varnish |
222 |
222 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
37 |
$3K |
| D9110 |
|
51 |
50 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
26 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
57 |
$319.93 |
| D1999 |
|
189 |
162 |
$0.00 |