| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,404 |
3,213 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,249 |
3,953 |
$114K |
| D1351 |
Sealant - per tooth |
1,661 |
707 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,065 |
2,916 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,288 |
849 |
$75K |
| D1110 |
Prophylaxis - adult |
1,024 |
944 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,917 |
1,768 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
514 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
915 |
852 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
303 |
181 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
215 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,944 |
2,689 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,551 |
2,169 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
354 |
341 |
$8K |
| D1206 |
Topical application of fluoride varnish |
285 |
247 |
$7K |
| D0272 |
Bitewings - two radiographic images |
766 |
723 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
75 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
276 |
$4K |
| D2331 |
|
35 |
25 |
$2K |
| D2140 |
|
16 |
15 |
$586.15 |
| D1999 |
|
126 |
120 |
$0.00 |