| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,736 |
2,629 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,376 |
2,230 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
941 |
725 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,462 |
1,410 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
893 |
656 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
508 |
345 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,282 |
4,020 |
$24K |
| D1206 |
Topical application of fluoride varnish |
970 |
929 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,849 |
3,277 |
$22K |
| D1351 |
Sealant - per tooth |
295 |
156 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,204 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
913 |
878 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
804 |
778 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
39 |
25 |
$12K |
| D1110 |
Prophylaxis - adult |
245 |
211 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
25 |
$8K |
| D0272 |
Bitewings - two radiographic images |
786 |
755 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
74 |
$6K |
| D3310 |
|
22 |
13 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
66 |
60 |
$1K |
| D2950 |
|
21 |
16 |
$1K |
| D2332 |
|
12 |
12 |
$1K |