| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,358 |
7,130 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
8,153 |
7,912 |
$227K |
| D1351 |
Sealant - per tooth |
2,264 |
1,354 |
$185K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,776 |
6,565 |
$176K |
| D4341 |
|
639 |
428 |
$114K |
| D8670 |
Periodic orthodontic treatment visit |
475 |
468 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,360 |
1,154 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,956 |
3,800 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
11,160 |
10,682 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,400 |
1,154 |
$64K |
| D1110 |
Prophylaxis - adult |
1,271 |
1,261 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,104 |
2,030 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,000 |
9,639 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,722 |
1,648 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
379 |
328 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,069 |
1,993 |
$21K |
| D0270 |
|
2,834 |
2,788 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
270 |
229 |
$16K |
| D1206 |
Topical application of fluoride varnish |
403 |
397 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
83 |
$5K |
| D8999 |
|
90 |
86 |
$4K |
| D9110 |
|
66 |
62 |
$4K |
| D0330 |
Panoramic radiographic image |
149 |
143 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
26 |
$3K |
| D2331 |
|
18 |
13 |
$1K |
| D2140 |
|
18 |
12 |
$678.68 |