| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,101 |
1,053 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,192 |
1,138 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,077 |
1,030 |
$27K |
| D1351 |
Sealant - per tooth |
207 |
156 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
83 |
$14K |
| D0274 |
Bitewings - four radiographic images |
742 |
694 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
162 |
$12K |
| D0330 |
Panoramic radiographic image |
380 |
361 |
$8K |
| D9110 |
|
150 |
134 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
111 |
98 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
308 |
$7K |
| D1110 |
Prophylaxis - adult |
166 |
156 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
94 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
36 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
488 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
37 |
$3K |
| D0272 |
Bitewings - two radiographic images |
283 |
275 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
351 |
328 |
$2K |
| D2160 |
|
34 |
30 |
$2K |
| D4342 |
|
20 |
14 |
$2K |
| D2140 |
|
13 |
12 |
$431.90 |