| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,450 |
8,099 |
$340K |
| D0120 |
Periodic oral evaluation - established patient |
9,575 |
9,203 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,058 |
7,725 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,937 |
1,533 |
$129K |
| D8670 |
Periodic orthodontic treatment visit |
527 |
483 |
$115K |
| D1351 |
Sealant - per tooth |
1,639 |
968 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,263 |
5,041 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,869 |
1,471 |
$82K |
| D1110 |
Prophylaxis - adult |
1,332 |
1,286 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
8,093 |
7,406 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,788 |
1,700 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,069 |
6,511 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,236 |
1,163 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,956 |
1,851 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
171 |
118 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
36 |
24 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
122 |
$9K |
| D4341 |
|
24 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
52 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
253 |
$3K |
| D0330 |
Panoramic radiographic image |
120 |
114 |
$1K |
| D2950 |
|
16 |
13 |
$1K |
| D9110 |
|
13 |
12 |
$715.00 |
| D1999 |
|
22 |
19 |
$0.00 |