| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,745 |
7,479 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
8,190 |
7,869 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,901 |
5,708 |
$150K |
| D1351 |
Sealant - per tooth |
2,079 |
981 |
$130K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
786 |
336 |
$57K |
| D1354 |
|
1,690 |
917 |
$44K |
| D1110 |
Prophylaxis - adult |
772 |
746 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,938 |
2,809 |
$29K |
| D0330 |
Panoramic radiographic image |
928 |
871 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
666 |
632 |
$15K |
| D0274 |
Bitewings - four radiographic images |
673 |
661 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
138 |
$11K |
| D2140 |
|
137 |
73 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
19 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
93 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
57 |
$319.20 |