| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,076 |
6,578 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
5,333 |
4,671 |
$129K |
| D1206 |
Topical application of fluoride varnish |
5,593 |
4,478 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,778 |
1,929 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,721 |
2,273 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
927 |
534 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,833 |
1,523 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
844 |
501 |
$59K |
| D0330 |
Panoramic radiographic image |
1,158 |
910 |
$50K |
| D2140 |
|
717 |
487 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,583 |
2,075 |
$28K |
| D1351 |
Sealant - per tooth |
803 |
162 |
$21K |
| D2160 |
|
210 |
134 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
501 |
448 |
$9K |
| D0272 |
Bitewings - two radiographic images |
495 |
370 |
$8K |
| D0350 |
|
233 |
220 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
231 |
138 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
28 |
$707.30 |