| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,497 |
5,478 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
8,526 |
8,480 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,394 |
8,349 |
$248K |
| D1110 |
Prophylaxis - adult |
3,474 |
3,438 |
$238K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,745 |
1,139 |
$157K |
| D0272 |
Bitewings - two radiographic images |
3,834 |
3,799 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
654 |
496 |
$75K |
| D1351 |
Sealant - per tooth |
1,166 |
289 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
90 |
$11K |
| D9110 |
|
139 |
134 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
493 |
487 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
436 |
353 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
86 |
$5K |
| D2140 |
|
29 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |