| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,339 |
4,211 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
4,996 |
4,828 |
$137K |
| D1110 |
Prophylaxis - adult |
1,782 |
1,715 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,600 |
2,521 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,078 |
930 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,151 |
978 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
656 |
484 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,997 |
1,917 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,377 |
2,290 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
6,913 |
6,583 |
$39K |
| D1351 |
Sealant - per tooth |
508 |
321 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,972 |
5,716 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,100 |
2,020 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
688 |
654 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
86 |
$6K |
| D0270 |
|
954 |
907 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
16 |
$226.00 |