| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,118 |
1,100 |
$48K |
| D1120 |
Prophylaxis - child |
1,275 |
1,243 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
667 |
651 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,577 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,726 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
100 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
102 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
445 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
235 |
69 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
27 |
$7K |
| D1351 |
Sealant - per tooth |
146 |
31 |
$4K |
| D0274 |
Bitewings - four radiographic images |
147 |
138 |
$4K |
| D1206 |
Topical application of fluoride varnish |
81 |
80 |
$2K |