| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,019 |
1,003 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,287 |
1,263 |
$44K |
| D1110 |
Prophylaxis - adult |
649 |
629 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,449 |
1,424 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,763 |
1,717 |
$37K |
| D2140 |
|
311 |
227 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
129 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
103 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
167 |
116 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,158 |
1,136 |
$19K |
| D0274 |
Bitewings - four radiographic images |
415 |
409 |
$18K |
| D0272 |
Bitewings - two radiographic images |
562 |
562 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
223 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
244 |
$12K |
| D0330 |
Panoramic radiographic image |
112 |
107 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
341 |
248 |
$9K |
| D1351 |
Sealant - per tooth |
371 |
129 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
25 |
$3K |