| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,287 |
11,871 |
$490K |
| D0120 |
Periodic oral evaluation - established patient |
13,434 |
12,933 |
$368K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,999 |
1,846 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,327 |
8,068 |
$212K |
| D1351 |
Sealant - per tooth |
1,665 |
878 |
$104K |
| D2140 |
|
2,066 |
1,346 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,594 |
1,203 |
$81K |
| D1110 |
Prophylaxis - adult |
1,529 |
1,462 |
$53K |
| D0272 |
Bitewings - two radiographic images |
4,330 |
4,145 |
$42K |
| D0330 |
Panoramic radiographic image |
1,507 |
1,427 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,719 |
1,647 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,371 |
1,299 |
$29K |
| D2160 |
|
124 |
93 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
570 |
536 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
553 |
505 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
71 |
$797.20 |