| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,606 |
4,405 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
4,908 |
4,587 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,315 |
2,129 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,210 |
2,197 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
804 |
543 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,663 |
1,502 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
498 |
442 |
$25K |
| D1351 |
Sealant - per tooth |
354 |
246 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
317 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,408 |
3,112 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
884 |
819 |
$19K |
| D1110 |
Prophylaxis - adult |
456 |
411 |
$18K |
| D2140 |
|
402 |
291 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,067 |
2,728 |
$14K |
| D0272 |
Bitewings - two radiographic images |
807 |
788 |
$9K |
| D2160 |
|
55 |
46 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
140 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
37 |
$2K |
| D1354 |
|
55 |
30 |
$2K |
| D1999 |
|
591 |
514 |
$0.00 |