| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,300 |
4,295 |
$236K |
| D1120 |
Prophylaxis - child |
5,847 |
5,839 |
$228K |
| D1351 |
Sealant - per tooth |
3,720 |
978 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,025 |
5,409 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,274 |
1,270 |
$76K |
| D1310 |
|
1,544 |
1,544 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,455 |
2,454 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,446 |
4,440 |
$48K |
| D9993 |
|
695 |
695 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
377 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,398 |
1,398 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,983 |
1,983 |
$23K |
| D0350 |
|
2,361 |
1,490 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
197 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
206 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
274 |
$12K |
| D0602 |
|
748 |
748 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
923 |
$11K |
| D1110 |
Prophylaxis - adult |
165 |
165 |
$10K |
| D9430 |
|
289 |
285 |
$9K |
| D4341 |
|
102 |
27 |
$6K |
| D0603 |
|
275 |
275 |
$4K |
| D4910 |
|
25 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |