| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,160 |
10,059 |
$1.04M |
| D1351 |
Sealant - per tooth |
10,412 |
2,176 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,780 |
1,694 |
$294K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,820 |
1,840 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,229 |
1,207 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,957 |
1,135 |
$120K |
| D1120 |
Prophylaxis - child |
9,104 |
8,999 |
$114K |
| D2140 |
|
2,501 |
1,426 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,536 |
6,437 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
10,522 |
10,353 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
741 |
732 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,815 |
2,805 |
$48K |
| D1206 |
Topical application of fluoride varnish |
7,513 |
7,457 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,425 |
4,335 |
$35K |
| D1110 |
Prophylaxis - adult |
1,788 |
1,775 |
$34K |
| D0330 |
Panoramic radiographic image |
1,583 |
1,551 |
$32K |
| D2332 |
|
386 |
245 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
323 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
205 |
138 |
$21K |
| D2330 |
|
261 |
161 |
$16K |
| D2160 |
|
100 |
72 |
$3K |
| D9248 |
|
13 |
13 |
$2K |
| D2331 |
|
15 |
12 |
$574.34 |
| D1999 |
|
189 |
185 |
$525.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
81 |
79 |
$139.30 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$0.00 |