| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,296 |
6,906 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
8,940 |
8,504 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,011 |
3,106 |
$172K |
| D8670 |
Periodic orthodontic treatment visit |
758 |
717 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,187 |
1,788 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,701 |
3,515 |
$94K |
| D0330 |
Panoramic radiographic image |
3,785 |
3,629 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,457 |
1,024 |
$77K |
| D4341 |
|
378 |
196 |
$74K |
| D1110 |
Prophylaxis - adult |
1,735 |
1,678 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,466 |
2,353 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,210 |
2,123 |
$36K |
| D1351 |
Sealant - per tooth |
507 |
272 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
863 |
837 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,365 |
1,285 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,611 |
1,530 |
$9K |
| D2330 |
|
88 |
49 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
331 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$1K |