| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,602 |
3,401 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,742 |
3,481 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,243 |
958 |
$86K |
| D1351 |
Sealant - per tooth |
873 |
546 |
$74K |
| D4341 |
|
294 |
180 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,873 |
2,687 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,241 |
2,072 |
$49K |
| D1110 |
Prophylaxis - adult |
1,118 |
1,031 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
367 |
307 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
726 |
563 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
1,193 |
1,099 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,568 |
1,440 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,384 |
1,295 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,361 |
2,195 |
$14K |
| D9110 |
|
206 |
200 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
35 |
32 |
$10K |
| D0272 |
Bitewings - two radiographic images |
677 |
615 |
$7K |
| D1206 |
Topical application of fluoride varnish |
213 |
201 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
42 |
$5K |
| D2950 |
|
81 |
75 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
954 |
$4K |
| D4342 |
|
17 |
16 |
$4K |
| D2331 |
|
13 |
12 |
$930.30 |
| D4910 |
|
12 |
12 |
$603.00 |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$271.20 |
| D0190 |
|
514 |
277 |
$0.00 |
| D1999 |
|
353 |
281 |
$0.00 |