| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,106 |
7,932 |
$365K |
| D0120 |
Periodic oral evaluation - established patient |
10,204 |
8,742 |
$279K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,715 |
6,763 |
$195K |
| D1351 |
Sealant - per tooth |
3,203 |
1,521 |
$176K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,604 |
867 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,790 |
4,137 |
$77K |
| D1110 |
Prophylaxis - adult |
1,718 |
1,495 |
$66K |
| D4341 |
|
292 |
120 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
903 |
581 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,516 |
5,398 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,792 |
1,545 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,222 |
1,051 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,784 |
4,439 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
525 |
365 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,562 |
1,355 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
741 |
654 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
95 |
$10K |
| D2160 |
|
96 |
65 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
100 |
$5K |
| D2140 |
|
108 |
86 |
$4K |
| D2331 |
|
75 |
26 |
$3K |
| D2335 |
|
34 |
15 |
$2K |
| D2332 |
|
30 |
12 |
$2K |
| D4342 |
|
13 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$803.60 |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
37 |
$319.50 |
| D1999 |
|
2,704 |
2,515 |
$0.00 |