| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,990 |
1,916 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,115 |
2,034 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,725 |
1,655 |
$43K |
| D1351 |
Sealant - per tooth |
282 |
201 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,203 |
1,152 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
158 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,226 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
118 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
416 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,034 |
1,926 |
$9K |
| D1110 |
Prophylaxis - adult |
142 |
133 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
180 |
$5K |
| D0272 |
Bitewings - two radiographic images |
448 |
430 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
213 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
46 |
$3K |
| D2160 |
|
19 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
24 |
$1K |
| D2140 |
|
18 |
12 |
$1K |
| D9110 |
|
13 |
12 |
$715.00 |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
50 |
$691.20 |
| D0270 |
|
20 |
20 |
$106.40 |
| D1999 |
|
221 |
168 |
$0.00 |