| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,796 |
5,732 |
$245K |
| D1351 |
Sealant - per tooth |
4,247 |
1,434 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
6,958 |
6,868 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,778 |
5,707 |
$154K |
| D4341 |
|
906 |
372 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,985 |
1,221 |
$128K |
| D0274 |
Bitewings - four radiographic images |
6,531 |
6,431 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
768 |
537 |
$74K |
| D1110 |
Prophylaxis - adult |
1,546 |
1,523 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,848 |
2,807 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
740 |
552 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
9,137 |
8,953 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,131 |
8,455 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
751 |
528 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
889 |
661 |
$39K |
| D4342 |
|
331 |
149 |
$39K |
| D2740 |
Crown - porcelain/ceramic |
92 |
81 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,072 |
1,021 |
$20K |
| D0330 |
Panoramic radiographic image |
533 |
519 |
$10K |
| D0603 |
|
71 |
71 |
$9K |
| D0272 |
Bitewings - two radiographic images |
942 |
929 |
$8K |
| D4910 |
|
103 |
103 |
$7K |
| D2335 |
|
65 |
55 |
$7K |
| D0601 |
|
52 |
52 |
$4K |
| D2332 |
|
33 |
26 |
$4K |
| D2950 |
|
35 |
30 |
$2K |
| D0602 |
|
13 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
272 |
267 |
$1K |
| D0270 |
|
54 |
54 |
$302.40 |