| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,287 |
4,135 |
$176K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,400 |
1,243 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,181 |
4,958 |
$138K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,511 |
957 |
$130K |
| D4341 |
|
798 |
469 |
$116K |
| D1206 |
Topical application of fluoride varnish |
3,833 |
3,714 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,421 |
1,061 |
$81K |
| D1351 |
Sealant - per tooth |
1,182 |
542 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,785 |
2,631 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,785 |
3,602 |
$64K |
| D1110 |
Prophylaxis - adult |
1,088 |
1,051 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
7,587 |
7,216 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
531 |
444 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,949 |
6,529 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
635 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,200 |
1,106 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,097 |
1,061 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,422 |
1,381 |
$14K |
| D0330 |
Panoramic radiographic image |
1,028 |
997 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
790 |
651 |
$13K |
| D5110 |
|
25 |
25 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
353 |
$9K |
| D4342 |
|
107 |
53 |
$8K |
| D2332 |
|
70 |
54 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
82 |
$6K |
| D5120 |
|
13 |
13 |
$6K |
| D2331 |
|
49 |
39 |
$3K |
| D2335 |
|
14 |
14 |
$1K |
| D2950 |
|
13 |
12 |
$1K |
| D0270 |
|
14 |
13 |
$72.80 |