| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,253 |
3,093 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
3,441 |
3,250 |
$89K |
| D1351 |
Sealant - per tooth |
2,037 |
686 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,142 |
2,987 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
894 |
567 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
583 |
308 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,159 |
2,021 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
461 |
326 |
$23K |
| D9110 |
|
444 |
399 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
978 |
915 |
$20K |
| D0330 |
Panoramic radiographic image |
830 |
787 |
$18K |
| D1110 |
Prophylaxis - adult |
505 |
464 |
$15K |
| D2160 |
|
233 |
190 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
226 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
150 |
$10K |
| D2140 |
|
266 |
175 |
$9K |
| D0272 |
Bitewings - two radiographic images |
985 |
936 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,532 |
1,426 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,102 |
979 |
$7K |
| D2332 |
|
80 |
62 |
$6K |
| D4342 |
|
43 |
26 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
58 |
$4K |
| D2331 |
|
55 |
41 |
$3K |
| D2335 |
|
33 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
86 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$62.20 |
| D1999 |
|
107 |
89 |
$0.00 |