| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,379 |
8,850 |
$385K |
| D0120 |
Periodic oral evaluation - established patient |
9,347 |
8,827 |
$262K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,081 |
8,558 |
$235K |
| D1351 |
Sealant - per tooth |
3,358 |
2,249 |
$225K |
| D1354 |
|
5,178 |
4,216 |
$201K |
| D0272 |
Bitewings - two radiographic images |
3,267 |
3,049 |
$33K |
| D9110 |
|
281 |
277 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,325 |
2,143 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
52 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
32 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
457 |
416 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
57 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$586.80 |