| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,944 |
4,693 |
$201K |
| D1351 |
Sealant - per tooth |
1,731 |
1,127 |
$146K |
| D4341 |
|
763 |
367 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,149 |
4,891 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,292 |
2,152 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
420 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,127 |
1,985 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,283 |
1,226 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,107 |
1,107 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
4,467 |
4,115 |
$26K |
| D1110 |
Prophylaxis - adult |
548 |
528 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
323 |
254 |
$23K |
| D9110 |
|
418 |
400 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
597 |
588 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
141 |
$17K |
| D4910 |
|
239 |
239 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,726 |
3,423 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
230 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,051 |
991 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
333 |
323 |
$6K |
| D4342 |
|
43 |
27 |
$6K |
| D2140 |
|
109 |
87 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
28 |
$3K |
| D1354 |
|
64 |
30 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$1K |
| D0270 |
|
240 |
239 |
$1K |