| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,732 |
2,678 |
$74K |
| D1110 |
Prophylaxis - adult |
1,563 |
1,531 |
$73K |
| D1120 |
Prophylaxis - child |
1,760 |
1,727 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,001 |
1,968 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,653 |
1,622 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,545 |
1,298 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
271 |
168 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,835 |
1,585 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
354 |
350 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
97 |
$15K |
| D1351 |
Sealant - per tooth |
474 |
124 |
$12K |
| D1206 |
Topical application of fluoride varnish |
322 |
316 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
40 |
$3K |
| D2140 |
|
47 |
32 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$948.84 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$240.00 |