| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,454 |
1,446 |
$61K |
| D1120 |
Prophylaxis - child |
1,542 |
1,535 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
811 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
663 |
317 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
592 |
319 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
417 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,148 |
1,144 |
$19K |
| D9430 |
|
544 |
522 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,055 |
1,949 |
$16K |
| D2160 |
|
170 |
89 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
103 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
100 |
$10K |
| D1206 |
Topical application of fluoride varnish |
839 |
839 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
689 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
94 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D2140 |
|
68 |
37 |
$4K |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$3K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$336.00 |
| D0180 |
|
13 |
13 |
$0.00 |