| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,988 |
11,401 |
$486K |
| D0120 |
Periodic oral evaluation - established patient |
13,828 |
13,127 |
$380K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,947 |
11,373 |
$307K |
| D1351 |
Sealant - per tooth |
3,137 |
2,068 |
$257K |
| D4341 |
|
807 |
486 |
$129K |
| D0274 |
Bitewings - four radiographic images |
6,407 |
6,090 |
$114K |
| D1110 |
Prophylaxis - adult |
2,244 |
2,120 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,358 |
1,099 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,282 |
3,099 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,078 |
853 |
$67K |
| D2140 |
|
1,457 |
1,166 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
10,365 |
9,794 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,843 |
8,394 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,609 |
2,329 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,512 |
3,313 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
295 |
247 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
310 |
304 |
$4K |
| D2940 |
|
42 |
19 |
$655.40 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$473.20 |
| D1999 |
|
2,485 |
1,940 |
$0.00 |