| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
2,714 |
2,667 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,370 |
2,330 |
$79K |
| D1120 |
Prophylaxis - child |
1,812 |
1,782 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
592 |
412 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,406 |
1,390 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
336 |
$52K |
| D1110 |
Prophylaxis - adult |
811 |
798 |
$49K |
| D0330 |
Panoramic radiographic image |
442 |
435 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
163 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
159 |
122 |
$23K |
| D2160 |
|
145 |
112 |
$21K |
| D1351 |
Sealant - per tooth |
403 |
122 |
$18K |
| D0272 |
Bitewings - two radiographic images |
539 |
529 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
117 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
171 |
$11K |
| D2140 |
|
105 |
72 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
139 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
86 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$1K |