| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,299 |
2,208 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,604 |
2,485 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,274 |
2,186 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
887 |
576 |
$47K |
| D1351 |
Sealant - per tooth |
933 |
468 |
$42K |
| D4341 |
|
150 |
66 |
$20K |
| D0274 |
Bitewings - four radiographic images |
985 |
936 |
$16K |
| D2140 |
|
470 |
361 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
757 |
719 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
188 |
$11K |
| D1110 |
Prophylaxis - adult |
315 |
294 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,488 |
1,374 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
286 |
267 |
$6K |
| D0272 |
Bitewings - two radiographic images |
584 |
563 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
936 |
806 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
253 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
29 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
40 |
$2K |
| D2160 |
|
16 |
12 |
$880.65 |
| D1999 |
|
105 |
97 |
$0.00 |