| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,736 |
4,484 |
$193K |
| D1351 |
Sealant - per tooth |
1,695 |
1,055 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
5,020 |
4,764 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,725 |
4,482 |
$122K |
| D9110 |
|
1,381 |
1,316 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
835 |
698 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,679 |
2,527 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
602 |
512 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,871 |
$43K |
| D1110 |
Prophylaxis - adult |
1,080 |
1,013 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,862 |
5,521 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
333 |
230 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,474 |
4,209 |
$24K |
| D4341 |
|
99 |
67 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
787 |
748 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
551 |
$11K |
| D0272 |
Bitewings - two radiographic images |
863 |
801 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
108 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
231 |
207 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
43 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D2394 |
|
14 |
13 |
$1K |
| D2335 |
|
12 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$275.00 |