| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,305 |
4,846 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,921 |
5,351 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,112 |
4,663 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,876 |
1,453 |
$110K |
| D1351 |
Sealant - per tooth |
1,068 |
666 |
$72K |
| D0274 |
Bitewings - four radiographic images |
4,100 |
3,708 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
680 |
428 |
$56K |
| D4341 |
|
328 |
204 |
$52K |
| D4342 |
|
427 |
281 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,856 |
1,674 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
973 |
799 |
$37K |
| D0330 |
Panoramic radiographic image |
1,718 |
1,557 |
$37K |
| D1110 |
Prophylaxis - adult |
1,006 |
913 |
$36K |
| D9110 |
|
614 |
544 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
474 |
315 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
473 |
382 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
311 |
213 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
74 |
50 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,675 |
1,529 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,846 |
1,547 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,258 |
2,038 |
$12K |
| D2332 |
|
59 |
53 |
$4K |
| D9630 |
|
164 |
113 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
127 |
$2K |
| D2331 |
|
27 |
26 |
$2K |
| D4910 |
|
12 |
12 |
$777.60 |
| D1999 |
|
1,776 |
1,155 |
$0.00 |