| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,705 |
6,273 |
$267K |
| D1351 |
Sealant - per tooth |
3,074 |
1,692 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,643 |
6,218 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,293 |
3,993 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,640 |
1,285 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,477 |
1,170 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,284 |
2,150 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,830 |
2,680 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
7,104 |
6,668 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,894 |
1,820 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
289 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
397 |
312 |
$27K |
| D1110 |
Prophylaxis - adult |
620 |
591 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,548 |
5,196 |
$22K |
| D4341 |
|
150 |
64 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,316 |
2,161 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
236 |
162 |
$19K |
| D5110 |
|
40 |
40 |
$15K |
| D0330 |
Panoramic radiographic image |
688 |
670 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
433 |
403 |
$6K |
| D9110 |
|
120 |
118 |
$6K |
| D5120 |
|
13 |
13 |
$5K |
| D2332 |
|
45 |
28 |
$4K |
| D0270 |
|
560 |
551 |
$3K |
| D2331 |
|
45 |
41 |
$3K |
| D2394 |
|
19 |
17 |
$1K |
| D2330 |
|
16 |
13 |
$761.20 |