| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,043 |
4,891 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
4,814 |
4,715 |
$136K |
| D1351 |
Sealant - per tooth |
1,895 |
996 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,218 |
4,084 |
$111K |
| D1110 |
Prophylaxis - adult |
1,588 |
1,562 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,975 |
2,870 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
7,485 |
7,211 |
$46K |
| D0272 |
Bitewings - two radiographic images |
4,132 |
4,000 |
$42K |
| D9110 |
|
699 |
645 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,721 |
6,508 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
209 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
297 |
225 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
163 |
124 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
72 |
$4K |
| D2140 |
|
48 |
44 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$709.38 |
| D0270 |
|
92 |
91 |
$504.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$194.40 |