| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,986 |
7,678 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
8,691 |
8,328 |
$240K |
| D1351 |
Sealant - per tooth |
3,601 |
1,483 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,720 |
6,485 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,305 |
1,557 |
$154K |
| D4341 |
|
507 |
301 |
$113K |
| D1110 |
Prophylaxis - adult |
2,510 |
2,400 |
$82K |
| D0274 |
Bitewings - four radiographic images |
4,664 |
4,442 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
10,962 |
10,439 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,737 |
2,589 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,251 |
845 |
$56K |
| D8670 |
Periodic orthodontic treatment visit |
245 |
236 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,018 |
10,077 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
813 |
639 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,145 |
2,050 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
148 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
623 |
585 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
549 |
$10K |
| D0330 |
Panoramic radiographic image |
458 |
448 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$1K |
| D4355 |
|
14 |
13 |
$451.00 |