| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,748 |
16,325 |
$688K |
| D1351 |
Sealant - per tooth |
11,240 |
5,544 |
$617K |
| D0120 |
Periodic oral evaluation - established patient |
16,173 |
15,794 |
$452K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,805 |
4,934 |
$429K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,743 |
12,425 |
$332K |
| D4341 |
|
1,537 |
597 |
$228K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,278 |
936 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,773 |
2,337 |
$208K |
| D0274 |
Bitewings - four radiographic images |
8,009 |
7,834 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,920 |
5,750 |
$137K |
| D2332 |
|
1,323 |
938 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
16,812 |
16,224 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,723 |
1,054 |
$98K |
| D1110 |
Prophylaxis - adult |
1,954 |
1,922 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
4,448 |
4,298 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,033 |
13,569 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,520 |
1,194 |
$56K |
| D5110 |
|
122 |
122 |
$52K |
| D0272 |
Bitewings - two radiographic images |
4,355 |
4,191 |
$43K |
| D1354 |
|
1,793 |
805 |
$36K |
| D5120 |
|
76 |
76 |
$33K |
| D2335 |
|
281 |
215 |
$30K |
| D0330 |
Panoramic radiographic image |
1,584 |
1,563 |
$28K |
| D9110 |
|
505 |
495 |
$26K |
| D0270 |
|
2,146 |
2,088 |
$12K |
| D2330 |
|
206 |
167 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
894 |
848 |
$11K |
| D2331 |
|
100 |
82 |
$8K |