| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,842 |
4,779 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,150 |
1,272 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
4,860 |
4,790 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,753 |
1,007 |
$108K |
| D1110 |
Prophylaxis - adult |
1,925 |
1,899 |
$79K |
| D1206 |
Topical application of fluoride varnish |
4,017 |
3,970 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,091 |
2,060 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,884 |
1,860 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,153 |
1,068 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
428 |
244 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
473 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,329 |
1,262 |
$14K |
| D2140 |
|
182 |
121 |
$11K |
| D1351 |
Sealant - per tooth |
287 |
79 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
69 |
$588.50 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$379.12 |
| D0601 |
|
110 |
108 |
$0.00 |