| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,919 |
8,518 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
9,358 |
8,877 |
$252K |
| D1351 |
Sealant - per tooth |
3,045 |
1,700 |
$223K |
| D1206 |
Topical application of fluoride varnish |
8,688 |
8,288 |
$218K |
| D0274 |
Bitewings - four radiographic images |
5,818 |
5,524 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,087 |
882 |
$76K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,405 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
9,517 |
8,934 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,459 |
2,374 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
630 |
447 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,551 |
8,023 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,772 |
2,643 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
289 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
829 |
792 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
169 |
$9K |
| D2140 |
|
108 |
91 |
$4K |
| D0330 |
Panoramic radiographic image |
113 |
112 |
$3K |
| D2160 |
|
46 |
39 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
48 |
$1K |
| D0270 |
|
145 |
134 |
$795.20 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$258.78 |
| D0601 |
|
247 |
238 |
$24.51 |
| D1999 |
|
629 |
541 |
$0.00 |
| D0602 |
|
28 |
28 |
$0.00 |