| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,772 |
7,434 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
9,389 |
8,924 |
$255K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,374 |
1,595 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,726 |
1,759 |
$226K |
| D2332 |
|
2,115 |
1,086 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,724 |
6,441 |
$172K |
| D1351 |
Sealant - per tooth |
1,980 |
932 |
$142K |
| D9110 |
|
1,819 |
1,721 |
$97K |
| D4341 |
|
354 |
182 |
$84K |
| D1110 |
Prophylaxis - adult |
2,103 |
1,984 |
$75K |
| D0274 |
Bitewings - four radiographic images |
3,688 |
3,471 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
7,411 |
6,949 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,722 |
1,626 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,038 |
5,627 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
247 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
177 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
227 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,462 |
1,394 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
212 |
$6K |
| D2335 |
|
17 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$998.00 |
| D0270 |
|
12 |
12 |
$67.20 |