| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,555 |
3,303 |
$144K |
| D1351 |
Sealant - per tooth |
1,277 |
878 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
3,993 |
3,713 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,536 |
3,286 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
629 |
474 |
$43K |
| D1110 |
Prophylaxis - adult |
891 |
861 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,085 |
1,964 |
$37K |
| D2140 |
|
604 |
429 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,109 |
1,033 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,501 |
2,302 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
688 |
642 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,126 |
1,030 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
144 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,557 |
1,443 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
61 |
$5K |
| D4341 |
|
35 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
63 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$366.10 |
| D1999 |
|
764 |
717 |
$0.00 |