| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,234 |
4,861 |
$211K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,421 |
1,405 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,728 |
1,664 |
$194K |
| D0140 |
Limited oral evaluation - problem focused |
8,149 |
7,101 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,962 |
9,040 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,222 |
1,691 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,975 |
4,146 |
$190K |
| D0330 |
Panoramic radiographic image |
5,610 |
3,662 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
7,015 |
6,429 |
$157K |
| D0274 |
Bitewings - four radiographic images |
5,342 |
4,766 |
$157K |
| D1110 |
Prophylaxis - adult |
4,771 |
4,219 |
$135K |
| D1351 |
Sealant - per tooth |
3,395 |
888 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,173 |
1,928 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,115 |
3,490 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
6,165 |
5,364 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
552 |
253 |
$34K |
| D7250 |
|
483 |
94 |
$31K |
| D9310 |
|
986 |
770 |
$14K |
| D7230 |
|
116 |
41 |
$11K |
| D2140 |
|
198 |
122 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
78 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
22 |
13 |
$6K |
| D2335 |
|
44 |
37 |
$5K |
| D0272 |
Bitewings - two radiographic images |
135 |
126 |
$4K |
| D2940 |
|
130 |
96 |
$4K |
| D1206 |
Topical application of fluoride varnish |
138 |
127 |
$3K |
| D2950 |
|
87 |
27 |
$2K |
| D2394 |
|
20 |
17 |
$2K |
| D8660 |
|
77 |
45 |
$874.38 |
| D0270 |
|
58 |
55 |
$316.12 |