| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,158 |
6,091 |
$313K |
| D0120 |
Periodic oral evaluation - established patient |
8,294 |
8,214 |
$241K |
| D1206 |
Topical application of fluoride varnish |
8,561 |
8,470 |
$224K |
| D1110 |
Prophylaxis - adult |
2,532 |
2,505 |
$173K |
| D1351 |
Sealant - per tooth |
4,030 |
787 |
$159K |
| D0330 |
Panoramic radiographic image |
968 |
951 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,640 |
2,607 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,343 |
1,333 |
$58K |
| D2394 |
|
212 |
80 |
$31K |
| D2335 |
|
206 |
78 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,238 |
1,193 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
907 |
817 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
54 |
$11K |
| D9110 |
|
167 |
158 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
42 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
36 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
88 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
17 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$2K |