| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,323 |
2,250 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,050 |
3,895 |
$116K |
| D1120 |
Prophylaxis - child |
3,010 |
2,892 |
$109K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
964 |
613 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,316 |
3,201 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,701 |
2,608 |
$56K |
| D1351 |
Sealant - per tooth |
1,848 |
413 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,938 |
2,495 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
378 |
247 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
888 |
860 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,281 |
2,837 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,045 |
1,000 |
$25K |
| D2140 |
|
110 |
80 |
$8K |
| D2160 |
|
39 |
25 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
42 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$1K |