| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,203 |
4,952 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,920 |
2,259 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,880 |
6,595 |
$164K |
| D1110 |
Prophylaxis - adult |
2,769 |
2,641 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,861 |
7,492 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,658 |
1,079 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,053 |
1,939 |
$51K |
| D0330 |
Panoramic radiographic image |
1,097 |
1,045 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
536 |
416 |
$32K |
| D1351 |
Sealant - per tooth |
1,517 |
436 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,519 |
1,451 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
898 |
847 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,425 |
1,319 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,724 |
927 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
138 |
$9K |
| D2331 |
|
46 |
38 |
$3K |
| D2335 |
|
17 |
12 |
$1K |
| D9110 |
|
42 |
39 |
$909.93 |
| D9986 |
|
2,023 |
1,578 |
$345.00 |
| D9987 |
|
654 |
522 |
$108.00 |