| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,237 |
3,181 |
$654K |
| D0140 |
Limited oral evaluation - problem focused |
2,195 |
2,051 |
$458K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,246 |
903 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
695 |
561 |
$119K |
| D1120 |
Prophylaxis - child |
1,526 |
1,502 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
313 |
$74K |
| D0190 |
|
155 |
155 |
$64K |
| D1110 |
Prophylaxis - adult |
1,728 |
1,705 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
173 |
$42K |
| D1351 |
Sealant - per tooth |
467 |
150 |
$34K |
| D1354 |
|
220 |
36 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,718 |
1,676 |
$8K |
| D0330 |
Panoramic radiographic image |
471 |
457 |
$7K |
| D0272 |
Bitewings - two radiographic images |
346 |
340 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
62 |
$5K |
| 512 |
|
47 |
46 |
$5K |
| D1206 |
Topical application of fluoride varnish |
3,053 |
3,005 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,932 |
1,818 |
$55.93 |