| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,013 |
16,991 |
$727K |
| D0120 |
Periodic oral evaluation - established patient |
18,167 |
17,154 |
$500K |
| D1351 |
Sealant - per tooth |
6,112 |
3,321 |
$406K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,835 |
12,173 |
$329K |
| D0274 |
Bitewings - four radiographic images |
5,099 |
4,835 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
11,943 |
11,208 |
$70K |
| D1110 |
Prophylaxis - adult |
1,530 |
1,479 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,923 |
2,787 |
$64K |
| D0272 |
Bitewings - two radiographic images |
5,486 |
5,087 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,296 |
10,591 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
354 |
266 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
670 |
646 |
$21K |
| D2140 |
|
220 |
168 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
54 |
$6K |
| D1206 |
Topical application of fluoride varnish |
226 |
221 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
85 |
$6K |
| D9110 |
|
96 |
94 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$226.80 |