| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,207 |
16,188 |
$695K |
| D0120 |
Periodic oral evaluation - established patient |
19,071 |
18,010 |
$525K |
| D1351 |
Sealant - per tooth |
5,105 |
2,775 |
$356K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,340 |
11,697 |
$317K |
| D1110 |
Prophylaxis - adult |
2,906 |
2,789 |
$123K |
| D0274 |
Bitewings - four radiographic images |
6,528 |
6,195 |
$118K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,203 |
898 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
12,417 |
11,669 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,204 |
3,040 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
939 |
718 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,108 |
864 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,701 |
10,982 |
$48K |
| D0272 |
Bitewings - two radiographic images |
4,868 |
4,494 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,303 |
1,259 |
$41K |
| D9110 |
|
644 |
608 |
$35K |
| D2140 |
|
554 |
431 |
$23K |
| D4341 |
|
141 |
70 |
$21K |
| D1206 |
Topical application of fluoride varnish |
120 |
114 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
41 |
$3K |
| D2160 |
|
14 |
12 |
$812.70 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$178.20 |