| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,505 |
4,254 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,178 |
1,493 |
$166K |
| D1351 |
Sealant - per tooth |
1,975 |
1,163 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,700 |
4,495 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,401 |
4,171 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,861 |
2,697 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,018 |
5,622 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,574 |
1,495 |
$36K |
| D1110 |
Prophylaxis - adult |
726 |
699 |
$31K |
| D9110 |
|
527 |
498 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
278 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,616 |
4,248 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,200 |
1,124 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
221 |
$12K |
| D4341 |
|
50 |
28 |
$8K |
| D0272 |
Bitewings - two radiographic images |
561 |
540 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
75 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
143 |
$2K |
| D0270 |
|
310 |
301 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$874.00 |