| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,233 |
13,215 |
$520K |
| D0120 |
Periodic oral evaluation - established patient |
11,711 |
11,701 |
$456K |
| D1351 |
Sealant - per tooth |
6,917 |
1,977 |
$208K |
| D0274 |
Bitewings - four radiographic images |
8,358 |
8,347 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,608 |
13,587 |
$175K |
| D1354 |
|
3,195 |
616 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,853 |
13,581 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,350 |
911 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,858 |
5,812 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,525 |
1,524 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,032 |
5,025 |
$62K |
| D2160 |
|
468 |
370 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
624 |
390 |
$35K |
| D0330 |
Panoramic radiographic image |
862 |
861 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
243 |
$26K |
| D1110 |
Prophylaxis - adult |
161 |
160 |
$15K |
| D9430 |
|
421 |
419 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
46 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$1K |