| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,701 |
2,533 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
2,446 |
2,304 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,420 |
2,279 |
$60K |
| D1351 |
Sealant - per tooth |
834 |
345 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
269 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,461 |
1,368 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,341 |
3,135 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,115 |
2,882 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
462 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
119 |
$10K |
| D1110 |
Prophylaxis - adult |
244 |
232 |
$7K |
| D9110 |
|
124 |
120 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
57 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
182 |
172 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
45 |
$3K |
| D0272 |
Bitewings - two radiographic images |
323 |
297 |
$3K |
| D2332 |
|
17 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$771.25 |
| D0270 |
|
96 |
91 |
$526.40 |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
88 |
$240.70 |