| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,140 |
5,793 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
6,500 |
6,114 |
$176K |
| D1206 |
Topical application of fluoride varnish |
6,016 |
5,689 |
$152K |
| D1351 |
Sealant - per tooth |
2,063 |
1,181 |
$124K |
| D9110 |
|
1,631 |
1,506 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,114 |
871 |
$77K |
| D8670 |
Periodic orthodontic treatment visit |
336 |
323 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,923 |
2,739 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,767 |
3,544 |
$23K |
| D1110 |
Prophylaxis - adult |
392 |
376 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
613 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
134 |
$13K |
| D2140 |
|
345 |
263 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
491 |
449 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,811 |
2,654 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
370 |
346 |
$6K |
| D2160 |
|
44 |
43 |
$3K |
| D8999 |
|
90 |
86 |
$3K |
| D0272 |
Bitewings - two radiographic images |
334 |
309 |
$3K |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$1K |