| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,356 |
10,707 |
$457K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,880 |
3,642 |
$408K |
| D0120 |
Periodic oral evaluation - established patient |
13,744 |
12,878 |
$373K |
| D4341 |
|
1,575 |
858 |
$360K |
| D1351 |
Sealant - per tooth |
3,957 |
1,928 |
$306K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,483 |
9,882 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,898 |
3,165 |
$260K |
| D2750 |
|
843 |
697 |
$232K |
| D1110 |
Prophylaxis - adult |
5,472 |
5,197 |
$219K |
| D0274 |
Bitewings - four radiographic images |
11,096 |
10,422 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,454 |
2,074 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,416 |
7,095 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,457 |
17,988 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
21,884 |
20,368 |
$122K |
| D9110 |
|
2,342 |
2,184 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
5,316 |
4,953 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,288 |
1,074 |
$53K |
| D8670 |
Periodic orthodontic treatment visit |
192 |
184 |
$45K |
| D0330 |
Panoramic radiographic image |
1,926 |
1,849 |
$41K |
| D2950 |
|
564 |
468 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
726 |
595 |
$37K |
| D2332 |
|
372 |
288 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,906 |
1,779 |
$17K |
| D4910 |
|
96 |
96 |
$6K |
| D1354 |
|
141 |
108 |
$4K |
| D2335 |
|
57 |
37 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
407 |
$3K |
| D8680 |
|
13 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
24 |
$2K |
| D2954 |
|
56 |
49 |
$2K |
| D9310 |
|
71 |
69 |
$1K |
| D0270 |
|
136 |
123 |
$752.64 |
| D1330 |
|
14 |
14 |
$0.00 |
| D1999 |
|
413 |
261 |
$0.00 |