| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,000 |
2,916 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,108 |
3,996 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,560 |
1,290 |
$110K |
| D1110 |
Prophylaxis - adult |
1,627 |
1,598 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
786 |
684 |
$75K |
| D4341 |
|
353 |
197 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,882 |
1,874 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,495 |
1,455 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,923 |
1,865 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
609 |
525 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
676 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,453 |
3,325 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,105 |
1,094 |
$19K |
| D9110 |
|
250 |
249 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,258 |
2,178 |
$11K |
| D0272 |
Bitewings - two radiographic images |
627 |
612 |
$7K |
| D2332 |
|
61 |
55 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
68 |
$6K |
| D1351 |
Sealant - per tooth |
63 |
38 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
26 |
$2K |
| D2331 |
|
14 |
12 |
$1K |
| D0270 |
|
15 |
15 |
$84.00 |