| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,903 |
2,879 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
5,472 |
5,425 |
$122K |
| D1120 |
Prophylaxis - child |
3,556 |
3,531 |
$120K |
| D1206 |
Topical application of fluoride varnish |
4,647 |
4,607 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
845 |
484 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,375 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,840 |
1,824 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
624 |
619 |
$38K |
| D1351 |
Sealant - per tooth |
865 |
227 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
479 |
470 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,282 |
$16K |
| D0272 |
Bitewings - two radiographic images |
895 |
894 |
$16K |
| D0330 |
Panoramic radiographic image |
339 |
337 |
$16K |
| D2140 |
|
133 |
98 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
40 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
597 |
314 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
15 |
$1K |
| D2740 |
Crown - porcelain/ceramic |
18 |
15 |
$1K |
| D4346 |
|
41 |
41 |
$0.00 |
| D1999 |
|
430 |
384 |
$0.00 |