| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,073 |
891 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
580 |
364 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
952 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
473 |
271 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
635 |
383 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,059 |
881 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,007 |
858 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
177 |
$16K |
| D1110 |
Prophylaxis - adult |
432 |
329 |
$14K |
| D1351 |
Sealant - per tooth |
275 |
114 |
$14K |
| D0274 |
Bitewings - four radiographic images |
881 |
700 |
$12K |
| D0330 |
Panoramic radiographic image |
621 |
499 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,875 |
1,496 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
67 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,694 |
1,288 |
$5K |
| D4341 |
|
29 |
16 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
226 |
182 |
$3K |
| D0272 |
Bitewings - two radiographic images |
409 |
335 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
217 |
184 |
$3K |
| D9110 |
|
40 |
40 |
$2K |
| D2330 |
|
18 |
16 |
$622.80 |