| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
638 |
611 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
679 |
651 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
603 |
577 |
$15K |
| D1110 |
Prophylaxis - adult |
381 |
373 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
127 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
464 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
129 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
221 |
213 |
$6K |
| D1351 |
Sealant - per tooth |
65 |
41 |
$5K |
| D0274 |
Bitewings - four radiographic images |
276 |
257 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
189 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
338 |
315 |
$2K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
122 |
$896.80 |
| D2140 |
|
22 |
18 |
$771.25 |
| D0270 |
|
13 |
12 |
$72.80 |