| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,329 |
3,318 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,789 |
1,003 |
$118K |
| D1120 |
Prophylaxis - child |
2,998 |
2,991 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,769 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
966 |
516 |
$114K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,289 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,348 |
855 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,648 |
1,647 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,405 |
4,689 |
$70K |
| D0350 |
|
3,574 |
2,140 |
$45K |
| D9430 |
|
1,248 |
1,221 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,555 |
3,543 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,124 |
2,119 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
38 |
27 |
$18K |
| D1206 |
Topical application of fluoride varnish |
964 |
964 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,395 |
1,386 |
$16K |
| D0330 |
Panoramic radiographic image |
665 |
664 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
917 |
897 |
$10K |
| D1351 |
Sealant - per tooth |
371 |
84 |
$8K |
| D2332 |
|
46 |
27 |
$4K |
| D2394 |
|
29 |
24 |
$2K |