| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
4,291 |
3,895 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,274 |
640 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,230 |
1,890 |
$77K |
| D1120 |
Prophylaxis - child |
1,919 |
1,772 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,038 |
603 |
$76K |
| D1110 |
Prophylaxis - adult |
2,273 |
2,073 |
$66K |
| D8670 |
Periodic orthodontic treatment visit |
816 |
763 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,267 |
1,143 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,436 |
2,299 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,259 |
2,049 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,944 |
1,765 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
580 |
217 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,676 |
2,397 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
408 |
146 |
$26K |
| D1351 |
Sealant - per tooth |
468 |
125 |
$16K |
| D8660 |
|
731 |
421 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
913 |
632 |
$9K |
| D0470 |
|
118 |
63 |
$5K |
| D2140 |
|
105 |
71 |
$5K |
| D0330 |
Panoramic radiographic image |
161 |
115 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
72 |
63 |
$2K |
| D2330 |
|
23 |
13 |
$878.00 |