| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,684 |
4,496 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
5,068 |
4,888 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,607 |
1,286 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,787 |
2,687 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
681 |
545 |
$68K |
| D1351 |
Sealant - per tooth |
950 |
559 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,813 |
1,740 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
796 |
639 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,991 |
1,924 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
5,779 |
5,494 |
$34K |
| D1110 |
Prophylaxis - adult |
759 |
743 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
955 |
943 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,818 |
4,568 |
$24K |
| D4341 |
|
91 |
53 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
901 |
867 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,582 |
1,475 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
112 |
$8K |
| D0270 |
|
906 |
869 |
$5K |
| D2394 |
|
30 |
26 |
$3K |
| D2332 |
|
14 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$226.00 |