| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,714 |
2,666 |
$247K |
| D0140 |
Limited oral evaluation - problem focused |
2,370 |
2,090 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,445 |
1,417 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
2,814 |
2,530 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,134 |
613 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
705 |
443 |
$64K |
| D1110 |
Prophylaxis - adult |
2,188 |
2,138 |
$48K |
| D0274 |
Bitewings - four radiographic images |
3,235 |
3,161 |
$48K |
| D0330 |
Panoramic radiographic image |
1,580 |
1,545 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
447 |
307 |
$31K |
| D2140 |
|
578 |
360 |
$29K |
| D1120 |
Prophylaxis - child |
1,535 |
1,521 |
$22K |
| D1206 |
Topical application of fluoride varnish |
2,510 |
2,472 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,220 |
681 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
75 |
$8K |
| D2331 |
|
115 |
69 |
$5K |
| D2160 |
|
48 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
214 |
211 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |