| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,217 |
5,994 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
6,442 |
6,035 |
$226K |
| D1206 |
Topical application of fluoride varnish |
6,002 |
5,790 |
$208K |
| D1351 |
Sealant - per tooth |
2,868 |
843 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,717 |
1,169 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,555 |
847 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,992 |
2,852 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,707 |
3,483 |
$68K |
| D1110 |
Prophylaxis - adult |
1,574 |
1,411 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,163 |
762 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,556 |
5,189 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
436 |
324 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,875 |
1,794 |
$23K |
| D0330 |
Panoramic radiographic image |
932 |
883 |
$22K |
| D1354 |
|
620 |
245 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,475 |
3,952 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
712 |
$13K |
| D5110 |
|
18 |
18 |
$7K |
| D5120 |
|
17 |
16 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
163 |
$4K |
| D2332 |
|
55 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
274 |
$3K |
| D2331 |
|
46 |
38 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
30 |
$2K |
| D1999 |
|
679 |
650 |
$0.00 |