| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,773 |
5,517 |
$235K |
| D1351 |
Sealant - per tooth |
1,871 |
1,029 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,541 |
5,297 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
4,852 |
4,657 |
$133K |
| D8670 |
Periodic orthodontic treatment visit |
435 |
401 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
4,804 |
4,597 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,652 |
1,582 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,211 |
1,122 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,474 |
4,221 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
345 |
246 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
1,050 |
993 |
$20K |
| D0330 |
Panoramic radiographic image |
574 |
525 |
$11K |
| D1110 |
Prophylaxis - adult |
279 |
263 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
72 |
$6K |
| D0272 |
Bitewings - two radiographic images |
532 |
505 |
$5K |
| D2140 |
|
111 |
89 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
40 |
$3K |
| D9110 |
|
57 |
53 |
$3K |
| D8680 |
|
20 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$229.44 |