| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,994 |
15,673 |
$807K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,415 |
18,024 |
$524K |
| D0120 |
Periodic oral evaluation - established patient |
16,473 |
16,157 |
$477K |
| D1351 |
Sealant - per tooth |
6,900 |
1,908 |
$274K |
| D0272 |
Bitewings - two radiographic images |
5,956 |
5,846 |
$178K |
| D1110 |
Prophylaxis - adult |
2,235 |
2,189 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,335 |
774 |
$119K |
| D1354 |
|
8,048 |
1,408 |
$114K |
| D7111 |
|
1,475 |
896 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
967 |
553 |
$107K |
| D0274 |
Bitewings - four radiographic images |
2,359 |
2,290 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,682 |
$94K |
| D0330 |
Panoramic radiographic image |
1,440 |
1,386 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
2,813 |
2,702 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
526 |
280 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,947 |
919 |
$27K |
| D1206 |
Topical application of fluoride varnish |
881 |
856 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
103 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
356 |
$17K |
| D2140 |
|
112 |
57 |
$8K |
| D1999 |
|
170 |
169 |
$0.00 |