| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,514 |
3,351 |
$99K |
| D1206 |
Topical application of fluoride varnish |
6,780 |
6,445 |
$89K |
| D1351 |
Sealant - per tooth |
3,964 |
500 |
$67K |
| D1120 |
Prophylaxis - child |
2,892 |
2,750 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,453 |
984 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,857 |
3,682 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,137 |
2,054 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
373 |
186 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,056 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,241 |
1,176 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
395 |
369 |
$16K |
| D2160 |
|
303 |
259 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
707 |
$14K |
| D2140 |
|
305 |
252 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
214 |
149 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
62 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
222 |
$2K |
| D0170 |
|
16 |
12 |
$217.60 |
| D0999 |
Unspecified diagnostic procedure, by report |
3,639 |
3,491 |
$0.00 |