| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,638 |
1,419 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,213 |
1,935 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
224 |
$24K |
| D1120 |
Prophylaxis - child |
1,265 |
1,092 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,898 |
1,628 |
$23K |
| D0274 |
Bitewings - four radiographic images |
977 |
838 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
563 |
270 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
600 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
473 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
98 |
$12K |
| D0330 |
Panoramic radiographic image |
375 |
306 |
$10K |
| D1351 |
Sealant - per tooth |
627 |
95 |
$6K |
| D2160 |
|
131 |
78 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
695 |
528 |
$4K |
| D0272 |
Bitewings - two radiographic images |
373 |
335 |
$4K |
| D0277 |
|
163 |
135 |
$4K |
| D2335 |
|
23 |
12 |
$3K |
| D2140 |
|
149 |
98 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$1K |