| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,434 |
5,733 |
$295K |
| D1110 |
Prophylaxis - adult |
5,054 |
4,337 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
9,502 |
8,374 |
$228K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,293 |
7,386 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,394 |
1,190 |
$194K |
| D0274 |
Bitewings - four radiographic images |
4,928 |
4,296 |
$174K |
| D1351 |
Sealant - per tooth |
2,311 |
540 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,300 |
648 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
1,460 |
1,240 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
906 |
782 |
$39K |
| D0330 |
Panoramic radiographic image |
327 |
311 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,493 |
1,255 |
$20K |
| D0272 |
Bitewings - two radiographic images |
621 |
546 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
109 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
144 |
84 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
87 |
$10K |
| D2335 |
|
22 |
14 |
$2K |
| D2330 |
|
37 |
16 |
$2K |
| D1330 |
|
56 |
56 |
$0.00 |