| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,058 |
1,976 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,702 |
3,395 |
$84K |
| D1110 |
Prophylaxis - adult |
2,484 |
2,205 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
804 |
470 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,806 |
1,666 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
261 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,106 |
1,047 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,097 |
1,018 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
448 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
522 |
502 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
132 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
925 |
813 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
71 |
51 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
406 |
174 |
$4K |
| D2140 |
|
44 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
19 |
13 |
$653.37 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$341.04 |