| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,314 |
3,179 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,340 |
735 |
$92K |
| D1351 |
Sealant - per tooth |
1,706 |
660 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,180 |
3,050 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,020 |
2,874 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
504 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,192 |
2,973 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,144 |
545 |
$60K |
| D4341 |
|
326 |
177 |
$49K |
| D0330 |
Panoramic radiographic image |
2,411 |
2,256 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,121 |
1,947 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,552 |
1,490 |
$24K |
| D1110 |
Prophylaxis - adult |
662 |
619 |
$21K |
| D8999 |
|
446 |
436 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
1,253 |
1,196 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
119 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
186 |
$13K |
| D5110 |
|
26 |
26 |
$10K |
| D2332 |
|
121 |
60 |
$8K |
| D0272 |
Bitewings - two radiographic images |
540 |
527 |
$5K |
| D2335 |
|
65 |
38 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
797 |
726 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
42 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
599 |
483 |
$4K |
| D8660 |
|
43 |
43 |
$4K |
| D2331 |
|
53 |
32 |
$3K |
| D2950 |
|
15 |
12 |
$754.65 |
| D1999 |
|
78 |
77 |
$0.00 |