| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,489 |
4,821 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
8,176 |
7,143 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,141 |
8,762 |
$126K |
| D1110 |
Prophylaxis - adult |
2,552 |
2,171 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,274 |
807 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
582 |
$74K |
| D0330 |
Panoramic radiographic image |
1,791 |
1,514 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
893 |
504 |
$49K |
| D2140 |
|
880 |
519 |
$41K |
| D1999 |
|
3,082 |
2,053 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,263 |
1,984 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,259 |
1,093 |
$26K |
| D1351 |
Sealant - per tooth |
926 |
201 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
441 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
325 |
296 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$464.00 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
17 |
$22.00 |
| D9920 |
|
12 |
12 |
$0.00 |