| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,518 |
9,403 |
$919K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,832 |
1,799 |
$214K |
| D1120 |
Prophylaxis - child |
10,723 |
10,569 |
$136K |
| D0272 |
Bitewings - two radiographic images |
6,568 |
6,485 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,197 |
471 |
$111K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,554 |
837 |
$103K |
| D1351 |
Sealant - per tooth |
2,576 |
465 |
$75K |
| D1206 |
Topical application of fluoride varnish |
11,344 |
11,183 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
8,320 |
8,208 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
569 |
201 |
$56K |
| D0330 |
Panoramic radiographic image |
1,756 |
1,735 |
$42K |
| D0274 |
Bitewings - four radiographic images |
2,604 |
2,576 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,886 |
7,782 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
432 |
423 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
221 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
53 |
$7K |
| D1110 |
Prophylaxis - adult |
269 |
261 |
$6K |
| D2140 |
|
39 |
14 |
$1K |