| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,640 |
5,399 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
6,508 |
6,228 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,216 |
1,640 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,389 |
5,159 |
$138K |
| D9110 |
|
2,192 |
2,032 |
$118K |
| D1351 |
Sealant - per tooth |
1,214 |
714 |
$94K |
| D1110 |
Prophylaxis - adult |
1,439 |
1,397 |
$60K |
| D0274 |
Bitewings - four radiographic images |
3,278 |
3,156 |
$57K |
| D4341 |
|
251 |
168 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
7,319 |
6,899 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,622 |
1,549 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,844 |
5,547 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
390 |
323 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,312 |
1,235 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
277 |
248 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,131 |
1,072 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
59 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
80 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
63 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
213 |
193 |
$4K |
| D0330 |
Panoramic radiographic image |
105 |
103 |
$2K |