| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,947 |
2,933 |
$114K |
| D2140 |
|
1,795 |
1,157 |
$111K |
| D1110 |
Prophylaxis - adult |
2,313 |
2,296 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,087 |
4,070 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,532 |
1,483 |
$102K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,100 |
733 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,166 |
3,153 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,391 |
1,356 |
$51K |
| D0274 |
Bitewings - four radiographic images |
924 |
917 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,154 |
1,152 |
$27K |
| D1351 |
Sealant - per tooth |
333 |
94 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
73 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
427 |
$6K |
| D1206 |
Topical application of fluoride varnish |
180 |
180 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
65 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D1999 |
|
25 |
19 |
$0.00 |