| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,642 |
9,553 |
$425K |
| D0120 |
Periodic oral evaluation - established patient |
14,207 |
13,860 |
$388K |
| D0274 |
Bitewings - four radiographic images |
9,748 |
9,553 |
$336K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,616 |
11,498 |
$299K |
| D1110 |
Prophylaxis - adult |
6,431 |
6,230 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,473 |
1,799 |
$207K |
| D1351 |
Sealant - per tooth |
4,337 |
942 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,896 |
2,846 |
$150K |
| D0140 |
Limited oral evaluation - problem focused |
4,092 |
3,962 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
8,886 |
8,574 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,195 |
5,729 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
817 |
540 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
557 |
411 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
367 |
312 |
$35K |
| D0272 |
Bitewings - two radiographic images |
357 |
356 |
$11K |
| D0330 |
Panoramic radiographic image |
113 |
104 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
25 |
$2K |