| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,236 |
6,921 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
6,152 |
5,894 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,540 |
5,284 |
$142K |
| D1351 |
Sealant - per tooth |
1,114 |
795 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,012 |
885 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,671 |
1,620 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,101 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
140 |
$13K |
| D2160 |
|
174 |
149 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,530 |
1,457 |
$9K |
| D0272 |
Bitewings - two radiographic images |
571 |
526 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
804 |
778 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
62 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
30 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
49 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$569.36 |
| D1999 |
|
16 |
16 |
$0.00 |