| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,859 |
3,709 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
4,140 |
3,978 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,029 |
777 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
973 |
658 |
$76K |
| D1351 |
Sealant - per tooth |
773 |
462 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,169 |
2,122 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
409 |
327 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,582 |
1,485 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,177 |
2,096 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,237 |
1,190 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
4,445 |
4,274 |
$28K |
| D1110 |
Prophylaxis - adult |
578 |
570 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
379 |
288 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,408 |
3,207 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
508 |
$9K |
| D0272 |
Bitewings - two radiographic images |
935 |
907 |
$9K |
| D2160 |
|
91 |
65 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
130 |
$7K |
| D2140 |
|
84 |
65 |
$3K |
| D2332 |
|
21 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$466.59 |
| D1999 |
|
104 |
96 |
$0.00 |