| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,879 |
1,710 |
$110K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
774 |
383 |
$43K |
| D0274 |
Bitewings - four radiographic images |
972 |
916 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,027 |
880 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,200 |
1,162 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,508 |
1,243 |
$27K |
| D0272 |
Bitewings - two radiographic images |
364 |
350 |
$20K |
| D2140 |
|
387 |
229 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
537 |
498 |
$13K |
| D1351 |
Sealant - per tooth |
301 |
76 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
98 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,215 |
1,158 |
$5K |
| D0330 |
Panoramic radiographic image |
332 |
289 |
$5K |
| D1120 |
Prophylaxis - child |
1,153 |
1,110 |
$4K |
| D0470 |
|
36 |
30 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
328 |
300 |
$1K |
| D0350 |
|
36 |
30 |
$0.00 |