| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,170 |
9,570 |
$388K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,770 |
3,446 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
11,814 |
11,095 |
$312K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,281 |
8,729 |
$227K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,909 |
2,838 |
$183K |
| D1351 |
Sealant - per tooth |
1,470 |
1,073 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,462 |
4,231 |
$75K |
| D1110 |
Prophylaxis - adult |
1,488 |
1,441 |
$64K |
| D4341 |
|
312 |
174 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,958 |
1,840 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
850 |
804 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
680 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
115 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
100 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,135 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
261 |
$6K |
| D2330 |
|
73 |
59 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
53 |
$3K |
| D8999 |
|
67 |
67 |
$2K |
| D2335 |
|
15 |
12 |
$865.20 |
| D0330 |
Panoramic radiographic image |
59 |
56 |
$751.78 |
| D2140 |
|
15 |
12 |
$555.30 |
| D1999 |
|
36 |
35 |
$0.00 |