| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,288 |
6,273 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
8,970 |
8,945 |
$208K |
| D0274 |
Bitewings - four radiographic images |
6,990 |
6,987 |
$159K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,303 |
954 |
$100K |
| D1120 |
Prophylaxis - child |
2,191 |
2,185 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,009 |
8,972 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,136 |
4,125 |
$55K |
| D1351 |
Sealant - per tooth |
745 |
369 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
862 |
341 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
716 |
627 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
528 |
214 |
$34K |
| D2140 |
|
455 |
356 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,132 |
2,120 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,138 |
1,132 |
$15K |
| D2330 |
|
41 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$197.58 |
| D1999 |
|
78 |
78 |
$0.00 |