| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,333 |
6,149 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
7,158 |
6,926 |
$197K |
| D1351 |
Sealant - per tooth |
2,501 |
1,273 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,263 |
6,083 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,813 |
1,369 |
$131K |
| D0274 |
Bitewings - four radiographic images |
4,664 |
4,508 |
$74K |
| D4341 |
|
324 |
152 |
$65K |
| D1110 |
Prophylaxis - adult |
1,348 |
1,336 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
650 |
547 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,404 |
2,341 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
8,009 |
7,680 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,824 |
7,143 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
678 |
541 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
998 |
957 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
304 |
252 |
$26K |
| D0601 |
|
324 |
324 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
384 |
311 |
$22K |
| D4342 |
|
113 |
63 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
910 |
$16K |
| D0602 |
|
154 |
154 |
$15K |
| D0603 |
|
152 |
152 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,575 |
1,510 |
$13K |
| D4910 |
|
31 |
31 |
$2K |
| D0330 |
Panoramic radiographic image |
79 |
77 |
$1K |
| D0270 |
|
14 |
12 |
$78.40 |