| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,914 |
6,653 |
$270K |
| D1206 |
Topical application of fluoride varnish |
4,901 |
4,820 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,044 |
2,828 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,426 |
579 |
$77K |
| D1110 |
Prophylaxis - adult |
1,568 |
1,514 |
$68K |
| D5110 |
|
165 |
160 |
$64K |
| D0330 |
Panoramic radiographic image |
2,434 |
2,305 |
$50K |
| D5120 |
|
112 |
107 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,693 |
2,611 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,563 |
1,446 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
397 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
778 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,582 |
3,443 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
712 |
665 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,463 |
1,436 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
698 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,999 |
1,958 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
139 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$1K |
| D2331 |
|
14 |
12 |
$778.50 |