| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,533 |
1,516 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
663 |
458 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,964 |
1,949 |
$55K |
| D1351 |
Sealant - per tooth |
883 |
350 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
143 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,127 |
1,118 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,331 |
1,312 |
$25K |
| D1110 |
Prophylaxis - adult |
516 |
514 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
282 |
$24K |
| D4341 |
|
173 |
75 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
881 |
867 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,582 |
2,528 |
$16K |
| D2332 |
|
131 |
89 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
528 |
523 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,014 |
1,973 |
$10K |
| D9110 |
|
166 |
164 |
$9K |
| D0330 |
Panoramic radiographic image |
442 |
441 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
286 |
286 |
$6K |
| D5120 |
|
14 |
14 |
$6K |
| D5110 |
|
13 |
13 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
67 |
$4K |
| D0272 |
Bitewings - two radiographic images |
322 |
319 |
$3K |