| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,738 |
3,332 |
$146K |
| D1351 |
Sealant - per tooth |
2,125 |
959 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
3,966 |
3,496 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,442 |
3,042 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
603 |
457 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
5,083 |
4,409 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,403 |
1,296 |
$23K |
| D4341 |
|
141 |
76 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
91 |
91 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
277 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
946 |
870 |
$19K |
| D1110 |
Prophylaxis - adult |
484 |
441 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,543 |
3,953 |
$17K |
| D2160 |
|
247 |
209 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
270 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
812 |
750 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,467 |
1,256 |
$13K |
| D2140 |
|
305 |
233 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
110 |
$8K |
| D0270 |
|
1,204 |
1,086 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
82 |
$6K |
| D0330 |
Panoramic radiographic image |
232 |
200 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
75 |
$3K |
| D1206 |
Topical application of fluoride varnish |
70 |
69 |
$2K |
| D8999 |
|
57 |
41 |
$2K |
| D9110 |
|
33 |
25 |
$2K |
| D2331 |
|
13 |
12 |
$830.40 |