| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,140 |
1,104 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,328 |
1,276 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,123 |
1,086 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
471 |
291 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
516 |
288 |
$21K |
| D2160 |
|
277 |
195 |
$17K |
| D1351 |
Sealant - per tooth |
313 |
133 |
$15K |
| D4341 |
|
102 |
40 |
$15K |
| D0274 |
Bitewings - four radiographic images |
879 |
835 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
657 |
$14K |
| D1110 |
Prophylaxis - adult |
351 |
328 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
69 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
985 |
931 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
819 |
704 |
$5K |
| D2140 |
|
107 |
78 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
36 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
46 |
$3K |
| D0272 |
Bitewings - two radiographic images |
235 |
228 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
31 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
88 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
150 |
145 |
$1K |
| D2161 |
|
15 |
14 |
$1K |