| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,164 |
5,831 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,882 |
1,000 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,683 |
7,054 |
$122K |
| D1110 |
Prophylaxis - adult |
3,236 |
2,998 |
$113K |
| D1120 |
Prophylaxis - child |
4,536 |
4,146 |
$95K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,486 |
534 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
649 |
280 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,220 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,954 |
4,370 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,054 |
1,859 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,035 |
1,834 |
$19K |
| D9999 |
Unspecified adjunctive procedure, by report |
707 |
627 |
$16K |
| D2140 |
|
289 |
116 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
506 |
$12K |
| D1351 |
Sealant - per tooth |
567 |
131 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,335 |
3,860 |
$9K |
| D2160 |
|
43 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
25 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
54 |
$1K |
| D9920 |
|
15 |
13 |
$365.27 |