| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,683 |
3,533 |
$150K |
| D4341 |
|
877 |
413 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,064 |
1,145 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,774 |
4,509 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,726 |
2,601 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
845 |
532 |
$65K |
| D9110 |
|
1,168 |
1,114 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
514 |
377 |
$45K |
| D1351 |
Sealant - per tooth |
810 |
331 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,409 |
2,273 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,387 |
1,315 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,633 |
1,579 |
$37K |
| D1110 |
Prophylaxis - adult |
952 |
899 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,335 |
4,101 |
$25K |
| D1206 |
Topical application of fluoride varnish |
651 |
627 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
372 |
192 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,549 |
3,344 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
127 |
$9K |
| D2752 |
|
29 |
25 |
$8K |
| D0330 |
Panoramic radiographic image |
205 |
200 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
150 |
$3K |
| D0272 |
Bitewings - two radiographic images |
266 |
255 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D2950 |
|
15 |
13 |
$870.75 |