| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,328 |
5,077 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
5,297 |
5,137 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,528 |
791 |
$107K |
| D1206 |
Topical application of fluoride varnish |
4,108 |
3,894 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,004 |
775 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,510 |
1,470 |
$33K |
| D1110 |
Prophylaxis - adult |
907 |
861 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
430 |
236 |
$32K |
| D0330 |
Panoramic radiographic image |
1,532 |
1,460 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
1,733 |
1,664 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
478 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,933 |
1,835 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,518 |
3,317 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,747 |
1,656 |
$15K |
| D1351 |
Sealant - per tooth |
336 |
98 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
862 |
803 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,469 |
2,107 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
62 |
$6K |
| D4341 |
|
17 |
13 |
$3K |
| D2335 |
|
13 |
12 |
$1K |