| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,275 |
2,142 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
990 |
762 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,232 |
2,084 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
538 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,885 |
1,779 |
$46K |
| D1110 |
Prophylaxis - adult |
988 |
935 |
$37K |
| D1351 |
Sealant - per tooth |
474 |
293 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
406 |
322 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,459 |
1,401 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
686 |
530 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
920 |
872 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,550 |
3,297 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,857 |
2,624 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,076 |
1,010 |
$17K |
| D2950 |
|
189 |
153 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
194 |
168 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
772 |
740 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
30 |
16 |
$11K |
| D3310 |
|
49 |
36 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
299 |
278 |
$7K |
| D0272 |
Bitewings - two radiographic images |
650 |
620 |
$6K |
| D2331 |
|
87 |
72 |
$5K |
| D2330 |
|
94 |
62 |
$4K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$271.20 |