| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,496 |
4,363 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
5,416 |
5,249 |
$152K |
| D1351 |
Sealant - per tooth |
1,741 |
1,087 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,397 |
4,259 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,424 |
1,224 |
$89K |
| D0274 |
Bitewings - four radiographic images |
3,895 |
3,766 |
$71K |
| D4341 |
|
348 |
254 |
$59K |
| D1110 |
Prophylaxis - adult |
1,222 |
1,189 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,093 |
2,028 |
$49K |
| D0330 |
Panoramic radiographic image |
1,720 |
1,666 |
$43K |
| D4342 |
|
275 |
204 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
725 |
638 |
$29K |
| D9110 |
|
449 |
425 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,721 |
2,623 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,006 |
1,916 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,215 |
1,169 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
133 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
14 |
14 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
41 |
$3K |
| D9630 |
|
104 |
98 |
$2K |
| D2950 |
|
19 |
19 |
$2K |
| D4910 |
|
12 |
12 |
$804.00 |
| D1999 |
|
845 |
670 |
$0.00 |