| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,265 |
4,146 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
4,366 |
4,233 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,478 |
696 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,057 |
2,987 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,815 |
1,748 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
646 |
285 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
682 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,300 |
1,259 |
$35K |
| D0330 |
Panoramic radiographic image |
546 |
517 |
$34K |
| D1110 |
Prophylaxis - adult |
884 |
851 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
743 |
678 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
111 |
$17K |
| D0272 |
Bitewings - two radiographic images |
283 |
279 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
93 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
487 |
455 |
$5K |
| D2140 |
|
36 |
29 |
$2K |
| D2332 |
|
29 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |