| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,380 |
2,297 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,655 |
2,563 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,255 |
2,174 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,976 |
1,877 |
$32K |
| D1110 |
Prophylaxis - adult |
800 |
748 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,206 |
$26K |
| D9110 |
|
424 |
382 |
$23K |
| D1351 |
Sealant - per tooth |
349 |
204 |
$22K |
| D4342 |
|
132 |
98 |
$17K |
| D0330 |
Panoramic radiographic image |
772 |
749 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
257 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
88 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
205 |
169 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
217 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,635 |
1,516 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,242 |
1,102 |
$9K |
| D0272 |
Bitewings - two radiographic images |
706 |
684 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
92 |
$5K |
| D4341 |
|
19 |
13 |
$3K |
| D2335 |
|
28 |
27 |
$2K |
| D2332 |
|
28 |
24 |
$2K |
| D2140 |
|
19 |
12 |
$617.00 |
| D9630 |
|
17 |
14 |
$211.50 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$20.80 |
| D1999 |
|
19 |
19 |
$0.00 |