| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,206 |
3,816 |
$177K |
| D1206 |
Topical application of fluoride varnish |
4,830 |
4,377 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
3,485 |
3,168 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
872 |
670 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,510 |
1,357 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,041 |
$35K |
| D0330 |
Panoramic radiographic image |
674 |
579 |
$34K |
| D1351 |
Sealant - per tooth |
1,171 |
297 |
$23K |
| D1110 |
Prophylaxis - adult |
480 |
435 |
$19K |
| D0272 |
Bitewings - two radiographic images |
950 |
899 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
677 |
615 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
931 |
812 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
92 |
$11K |
| D1354 |
|
253 |
87 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
54 |
$6K |
| D2140 |
|
111 |
91 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
87 |
$2K |
| D9310 |
|
85 |
85 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
15 |
$2K |
| D7111 |
|
36 |
14 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
14 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
62 |
$840.46 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$775.60 |