| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,356 |
4,226 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,042 |
5,821 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,944 |
1,024 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,402 |
5,236 |
$127K |
| D1110 |
Prophylaxis - adult |
2,147 |
2,073 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,527 |
1,457 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,340 |
2,245 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,776 |
1,708 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
430 |
248 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
277 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,489 |
2,346 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
231 |
$29K |
| D0330 |
Panoramic radiographic image |
352 |
308 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
311 |
296 |
$20K |
| D0272 |
Bitewings - two radiographic images |
627 |
610 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
718 |
$14K |
| D1351 |
Sealant - per tooth |
195 |
45 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
71 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
26 |
$4K |
| D2394 |
|
22 |
14 |
$4K |
| D2140 |
|
28 |
20 |
$1K |
| D0240 |
|
12 |
12 |
$428.26 |
| D1330 |
|
1,274 |
1,241 |
$0.00 |
| D1310 |
|
1,258 |
1,225 |
$0.00 |