| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,337 |
4,223 |
$178K |
| D1351 |
Sealant - per tooth |
1,888 |
921 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,257 |
5,150 |
$146K |
| D1110 |
Prophylaxis - adult |
2,974 |
2,910 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,155 |
4,055 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,859 |
3,717 |
$89K |
| D4341 |
|
280 |
138 |
$50K |
| D0330 |
Panoramic radiographic image |
1,909 |
1,895 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,356 |
1,301 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
365 |
274 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
900 |
871 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
227 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
471 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
102 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,079 |
1,024 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
26 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
99 |
$4K |
| D2160 |
|
30 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
206 |
$2K |
| D2331 |
|
14 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D2140 |
|
21 |
16 |
$800.80 |
| D0272 |
Bitewings - two radiographic images |
59 |
58 |
$554.60 |