| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,674 |
2,465 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,095 |
2,823 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,662 |
2,455 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
638 |
$54K |
| D1351 |
Sealant - per tooth |
1,013 |
484 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
817 |
500 |
$46K |
| D1110 |
Prophylaxis - adult |
840 |
750 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,829 |
1,629 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,089 |
996 |
$22K |
| D2160 |
|
314 |
224 |
$20K |
| D2140 |
|
400 |
258 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,841 |
1,195 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,655 |
1,468 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
127 |
98 |
$7K |
| D4341 |
|
37 |
15 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
302 |
$5K |
| D0272 |
Bitewings - two radiographic images |
531 |
488 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
503 |
469 |
$4K |
| D2950 |
|
38 |
25 |
$3K |
| D4342 |
|
29 |
12 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
17 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
28 |
$2K |
| D1999 |
|
620 |
431 |
$0.00 |