| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,109 |
4,927 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,171 |
1,506 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
5,251 |
5,094 |
$144K |
| D4341 |
|
420 |
204 |
$96K |
| D1351 |
Sealant - per tooth |
1,071 |
620 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
993 |
744 |
$64K |
| D8670 |
Periodic orthodontic treatment visit |
309 |
280 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,281 |
3,168 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,356 |
2,266 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,940 |
1,853 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
522 |
383 |
$47K |
| D1110 |
Prophylaxis - adult |
974 |
956 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
4,848 |
4,636 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,087 |
3,924 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
608 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
26 |
$2K |
| D9110 |
|
12 |
12 |
$660.00 |
| D0272 |
Bitewings - two radiographic images |
56 |
49 |
$546.47 |
| D8999 |
|
12 |
12 |
$423.45 |