| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,155 |
2,010 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,488 |
2,323 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
687 |
465 |
$53K |
| D1351 |
Sealant - per tooth |
593 |
359 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,766 |
1,661 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
284 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
950 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,260 |
1,177 |
$21K |
| D1110 |
Prophylaxis - adult |
504 |
477 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
104 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,795 |
1,646 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
532 |
$9K |
| D1206 |
Topical application of fluoride varnish |
348 |
310 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
76 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,105 |
1,018 |
$7K |
| D0272 |
Bitewings - two radiographic images |
601 |
560 |
$6K |
| D4341 |
|
31 |
14 |
$3K |
| D2160 |
|
51 |
40 |
$3K |
| D2140 |
|
70 |
53 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
31 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
39 |
$837.21 |
| D1999 |
|
695 |
530 |
$0.00 |