| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,708 |
1,613 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
750 |
580 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,599 |
1,489 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,238 |
1,175 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
591 |
468 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
234 |
180 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
872 |
$20K |
| D0274 |
Bitewings - four radiographic images |
929 |
838 |
$14K |
| D1351 |
Sealant - per tooth |
146 |
111 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,929 |
1,744 |
$10K |
| D4341 |
|
44 |
29 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,615 |
1,453 |
$7K |
| D1110 |
Prophylaxis - adult |
173 |
170 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
385 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
94 |
$5K |
| D1206 |
Topical application of fluoride varnish |
200 |
185 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
153 |
$5K |
| D0272 |
Bitewings - two radiographic images |
255 |
237 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
217 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$870.75 |
| D0330 |
Panoramic radiographic image |
51 |
48 |
$856.92 |