| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,655 |
5,638 |
$321K |
| D1120 |
Prophylaxis - child |
5,314 |
5,298 |
$207K |
| D1351 |
Sealant - per tooth |
4,175 |
1,024 |
$105K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,565 |
899 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
4,199 |
4,175 |
$90K |
| D2140 |
|
1,638 |
884 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
348 |
$39K |
| D1110 |
Prophylaxis - adult |
539 |
538 |
$20K |
| D1206 |
Topical application of fluoride varnish |
5,905 |
5,890 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
102 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,031 |
3,923 |
$7K |
| D0330 |
Panoramic radiographic image |
448 |
447 |
$7K |
| D0272 |
Bitewings - two radiographic images |
2,724 |
2,718 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
79 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,162 |
1,158 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D9986 |
|
12 |
12 |
$0.00 |