| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,863 |
1,758 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
615 |
331 |
$67K |
| D1110 |
Prophylaxis - adult |
1,205 |
1,143 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,062 |
1,954 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
468 |
268 |
$58K |
| D1351 |
Sealant - per tooth |
1,498 |
320 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,905 |
1,810 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,459 |
1,371 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
646 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,477 |
1,404 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,655 |
1,567 |
$28K |
| D1206 |
Topical application of fluoride varnish |
734 |
693 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
184 |
182 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
66 |
$7K |
| D2160 |
|
21 |
12 |
$4K |
| D2140 |
|
27 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$825.00 |