| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,423 |
5,393 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,295 |
1,047 |
$78K |
| D1120 |
Prophylaxis - child |
3,491 |
3,483 |
$58K |
| D1110 |
Prophylaxis - adult |
3,152 |
3,138 |
$45K |
| D2140 |
|
1,068 |
386 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,891 |
6,670 |
$36K |
| D1351 |
Sealant - per tooth |
966 |
133 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,649 |
3,641 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
7,477 |
7,365 |
$24K |
| D0272 |
Bitewings - two radiographic images |
3,899 |
3,894 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
965 |
959 |
$14K |
| D0191 |
|
715 |
658 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
320 |
316 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
53 |
$4K |
| D4355 |
|
24 |
24 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$757.13 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$344.00 |
| D1999 |
|
217 |
211 |
$0.00 |
| D1330 |
|
22 |
22 |
$0.00 |