| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,775 |
2,501 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,961 |
2,656 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,056 |
574 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,721 |
2,450 |
$61K |
| D4341 |
|
386 |
169 |
$52K |
| D2750 |
|
187 |
151 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
512 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,385 |
1,283 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,612 |
1,451 |
$23K |
| D1351 |
Sealant - per tooth |
397 |
201 |
$20K |
| D1110 |
Prophylaxis - adult |
564 |
517 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
204 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
314 |
233 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
385 |
275 |
$12K |
| D2950 |
|
202 |
161 |
$12K |
| D9110 |
|
229 |
201 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
693 |
613 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
648 |
$8K |
| D0330 |
Panoramic radiographic image |
477 |
423 |
$8K |
| D0272 |
Bitewings - two radiographic images |
438 |
394 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
718 |
645 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
25 |
$2K |
| D4910 |
|
28 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
215 |
191 |
$891.10 |
| D2331 |
|
17 |
12 |
$778.50 |