| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
606 |
594 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
737 |
715 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
600 |
588 |
$15K |
| D1351 |
Sealant - per tooth |
154 |
93 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
106 |
$8K |
| D1110 |
Prophylaxis - adult |
177 |
167 |
$7K |
| D0274 |
Bitewings - four radiographic images |
305 |
294 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
531 |
506 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
133 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
503 |
432 |
$2K |
| D2140 |
|
58 |
52 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
32 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
67 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
70 |
$985.40 |
| D0272 |
Bitewings - two radiographic images |
94 |
89 |
$836.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$493.60 |