| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,821 |
5,627 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
8,245 |
7,954 |
$222K |
| D1206 |
Topical application of fluoride varnish |
6,955 |
6,712 |
$175K |
| D1110 |
Prophylaxis - adult |
2,951 |
2,785 |
$166K |
| D9450 |
|
4,335 |
3,656 |
$83K |
| D0272 |
Bitewings - two radiographic images |
2,969 |
2,824 |
$81K |
| D1351 |
Sealant - per tooth |
1,353 |
402 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
257 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
147 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
499 |
485 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
212 |
152 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
53 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
199 |
190 |
$5K |
| D0330 |
Panoramic radiographic image |
81 |
77 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
62 |
$3K |
| D1999 |
|
4,377 |
3,877 |
$0.00 |
| D1330 |
|
100 |
100 |
$0.00 |