| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,330 |
4,081 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
6,277 |
5,906 |
$124K |
| D0272 |
Bitewings - two radiographic images |
3,464 |
3,249 |
$72K |
| D1206 |
Topical application of fluoride varnish |
2,552 |
2,414 |
$55K |
| D1120 |
Prophylaxis - child |
1,931 |
1,809 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
733 |
434 |
$44K |
| D1351 |
Sealant - per tooth |
1,722 |
248 |
$29K |
| D0330 |
Panoramic radiographic image |
506 |
466 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,196 |
1,107 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
202 |
99 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
434 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
171 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
24 |
$549.56 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
72 |
$532.50 |