| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,455 |
1,396 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,578 |
1,521 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
706 |
344 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
998 |
953 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
675 |
646 |
$14K |
| D0274 |
Bitewings - four radiographic images |
766 |
731 |
$11K |
| D1351 |
Sealant - per tooth |
242 |
82 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,873 |
1,786 |
$10K |
| D2140 |
|
304 |
182 |
$10K |
| D2160 |
|
164 |
102 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,496 |
1,394 |
$7K |
| D1110 |
Prophylaxis - adult |
183 |
174 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
72 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
210 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
322 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
52 |
$4K |
| D0272 |
Bitewings - two radiographic images |
299 |
288 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
14 |
$647.85 |