| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,134 |
21,672 |
$902K |
| D0120 |
Periodic oral evaluation - established patient |
21,280 |
20,836 |
$596K |
| D1206 |
Topical application of fluoride varnish |
12,133 |
11,889 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,126 |
3,305 |
$213K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,888 |
1,647 |
$173K |
| D1351 |
Sealant - per tooth |
1,944 |
744 |
$104K |
| D0272 |
Bitewings - two radiographic images |
6,625 |
6,501 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,080 |
919 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,513 |
1,349 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,988 |
1,942 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
659 |
604 |
$35K |
| D2140 |
|
736 |
602 |
$27K |
| D0999 |
Unspecified diagnostic procedure, by report |
149 |
122 |
$7K |
| D0330 |
Panoramic radiographic image |
46 |
44 |
$838.72 |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
103 |
$588.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
43 |
$0.00 |