| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,772 |
3,757 |
$190K |
| D1110 |
Prophylaxis - adult |
1,739 |
1,731 |
$146K |
| D1120 |
Prophylaxis - child |
3,487 |
3,472 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,378 |
5,892 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,754 |
$103K |
| D1351 |
Sealant - per tooth |
3,804 |
1,021 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,713 |
3,697 |
$78K |
| D1206 |
Topical application of fluoride varnish |
5,210 |
5,189 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
835 |
329 |
$53K |
| D2140 |
|
336 |
170 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
92 |
$16K |
| D0272 |
Bitewings - two radiographic images |
984 |
983 |
$11K |
| D0350 |
|
897 |
394 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
32 |
$5K |
| D2160 |
|
54 |
28 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
27 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
12 |
$2K |
| D9993 |
|
13 |
13 |
$10.00 |
| D1310 |
|
13 |
13 |
$0.00 |