| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
461 |
439 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
540 |
518 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
438 |
416 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
134 |
80 |
$7K |
| D0274 |
Bitewings - four radiographic images |
323 |
306 |
$5K |
| D1351 |
Sealant - per tooth |
132 |
38 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
69 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
171 |
$4K |
| D1110 |
Prophylaxis - adult |
139 |
137 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
231 |
224 |
$1K |
| D2140 |
|
36 |
25 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
27 |
$1K |
| D0272 |
Bitewings - two radiographic images |
95 |
88 |
$864.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
115 |
109 |
$748.60 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$275.40 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$163.60 |