| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,837 |
4,443 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,780 |
1,573 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,346 |
2,980 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,070 |
1,229 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,591 |
4,069 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,549 |
3,742 |
$90K |
| D1110 |
Prophylaxis - adult |
3,384 |
2,575 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,704 |
2,220 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,273 |
2,949 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,233 |
1,878 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,531 |
1,101 |
$56K |
| D0330 |
Panoramic radiographic image |
1,320 |
893 |
$56K |
| D1351 |
Sealant - per tooth |
934 |
236 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,647 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
303 |
55 |
$11K |
| D0272 |
Bitewings - two radiographic images |
301 |
281 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
301 |
101 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
41 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
240 |
122 |
$2K |
| D8660 |
|
28 |
26 |
$773.49 |
| D0603 |
|
3,680 |
3,179 |
$0.00 |