| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2160 |
|
555 |
290 |
$37K |
| D1110 |
Prophylaxis - adult |
989 |
969 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,965 |
1,831 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,491 |
1,413 |
$24K |
| D1120 |
Prophylaxis - child |
942 |
871 |
$22K |
| D1351 |
Sealant - per tooth |
906 |
151 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
754 |
721 |
$17K |
| D0274 |
Bitewings - four radiographic images |
635 |
614 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
254 |
180 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
491 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
235 |
$11K |
| D0330 |
Panoramic radiographic image |
256 |
250 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
554 |
514 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
39 |
$4K |
| D0603 |
|
448 |
443 |
$2K |
| D0272 |
Bitewings - two radiographic images |
118 |
115 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
66 |
$973.42 |